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Full text of "Healthy Mothers, Healthy Babies: A Compendium of Program Ideas for Serving Low-Income Women"

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Healthy Mothers, 
Healthy Babies 



A COMPENDIUM 
OF PROGRAM IDEAS 
FOR SERVING 
LOW-INCOME WOMEN 



Department of Health and Human Services 

U.S. Public Health Service 

Health Resources and Services Administration 



2 2 2 



///// 



OFFICE OF MINORITY HEALTH 

RESOURCE CENTER 

PO. BOX 37337 

WASHINGTON, D.C 20013-7337 






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Healthy Mothers, 
Healthy Babies: 



A COMPENDIUM 
OF PROGRAM IDEAS 
FOR SERVING 
LOW-INCOME WOMEN 



Myosin in^ion, DC ZOQL4-? 

on - 




January 1986 



Printed for the Healthy Mothers, Healthy Babies Coalition by: 
The Division of Maternal and Child Health, 
Health Resources and Services Administration, 
U.S. Public Health Service 

DHHS Publication No. (PHS) 86-50209 



The opinions expressed and programs described herein are those 
of the respondents to the Healthy Mothers, Healthy Babies Coalition 
National Survey and not those of the Division of Maternal and 
Child Health or of the Department of Health and Human Services. 
Inclusion here does not constitute Coalition or Federal 
government endorsement. 



For sale by the Superintendent of Documents, U.S. Government Printing Office 
Washington, DC 20402 



TABLE 

OF 

CONTENTS 



Introduction v 

How To Use This Report viii 

Executive Summary ix 

1 Healthy Mothers Market Research: 1 
Executive Summary of the Juarez Report 

2 Health Education for Low-Income Groups: 9 
A Review of the Literature 

3 Prepregnancy Programs 15 

4 Prenatal Services 19 

5 Postnatal Programs 30 

6 Comprehensive Programs 39 

7 Breastfeeding 48 

8 Nutrition 53 

• WIC (USDA Special Supplemental Food 
Program for Women, Infants and Children) 

•EFNEP (USDA Expanded Food and 
Nutrition Education Program) 

9 Substance Use During Pregnancy 60 

10 Rural Populations 64 

11 Native Americans 67 

12 Adolescent Pregnancy 70 

13 Resources 82 

• Healthy Mothers, Healthy Babies Coalition 

• National Coalition Members 

• State Coalitions 

• Clearinghouses 

• Resource Books and Directories 

Appendices 

A. Survey Instrument 92 

B. EPSDT (Early and Periodic Screening, 95 
Diagnosis and Treatment Program) 

C. NHeLP (National Health Law Program) 97 

D. Survey Respondents 99 



INTRODUCTION 



The Healthy Mothers, Healthy Babies Coalition is an 
informal association of nearly 80 national pro- 
fessional, voluntary, and governmental organizations 
with a common interest in maternal and infant 
health.* In addition to the National Coalition, more 
than 40 States have formed independent Healthy 
Mothers, Healthy Babies Coalitions. The purpose of 
the Coalition is to foster education efforts for pregnant 
women through collaborative activities and to share 
information and resources. Its goals are to: 

• PROMOTE public awareness and education in pre- 
ventive health habits for all pregnant women and 
their families 

• DEVELOP networks for sharing information among 
groups concerned about improving the health of 
mothers and babies 

• DISTRIBUTE public education materials on topics 
related to improving maternal and child health 

• ASSIST the development of State Healthy Mothers, 
Healthy Babies Coalitions 

Most of National Coalition program development is 
conducted through seven Subcommittees, including 
Breastfeeding, Oral Health, Substance Use During 
Pregnancy, Injury Prevention, Adolescent Pregnancy, 
Genetics, and Low-Income Women. This compendium 
is based on the work of the Low Income Women Sub- 
committee. 

The Subcommittee on Low-Income Women was 
formed in 1984 to address the educational needs of this 
high-risk audience, and to identify successful methods 
and strategies for motivating these women to seek 
early and regular prenatal care. Currently, the Sub- 
committee includes members representing 26 organi- 
zations. The Subcommittee works to: 

• Identify special communications problems, e.g., low 
literacy, language barriers, cultural sensitivities, and 
ethnic differences 

• Identify "proven methods" for dealing with these 
problems 

• Identify existing or planned low-income educational 
efforts among Coalition members and encourage 
development/support of outreach efforts by members 
not currently addressing the issue 



*List of National member organizations and State Coalitions are included in Chapter 13: 
Resources 



• Encourage National and State Coalition members to 
aid those across the country who provide services for 
low-income populations 

• Identify sources of support for developing materials/ 
strategies for low-income populations 

In the Spring of 1985, the Subcommittee conducted a 
nationwide survey of programs serving low-income 
women. Approximately 18,000 survey forms were dis- 
tributed through more than 20 National Coalition 
member organizations. A copy of the survey form is 
included as Appendix A. A total of 1,551 responses 
were received and reviewed by 24 subcommittee mem- 
bers for inclusion in this report. This report contains 
descriptions of selected programs, a summary of other 
responses with an emphasis on educational efforts and 
needs for educational materials. Also, a brief review of 
the literature addressing health information/ 
education among low income populations, results of 
Coalition market research with low income women, 
and a directory listing all survey respondents are in- 
cluded. We hope that this compendium will provide 
useful suggestions to health care providers who work 
with low-income populations, and will help provide 
program planning and policy direction to State and 
national organizations and government agencies con- 
cerned with maternal and infant health. 

Following the publication of this report, the Sub- 
committee will complete a needs inventory of educa- 
tional materials based on survey response, and en- 
courage Coalition members to address these needs as 
they plan new educational programs. Also, Sub- 
committee members will review educational materi- 
als submitted by survey respondents and seek ways of 
replicating and promoting the best of these. 

Suggestions for future projects are welcomed by the 
Subcommittee, and may be addressed to any member 
(addresses are included in Chapter 13: Resources). 
Finally, on behalf of the Coalition, I wish to thank the 
1,551 respondents, the 44 reviewers, Caroline McNeil 
who wrote the most difficult first draft of this com- 
pendium, and the other Subcommittee members who 
continue to work together on behalf of low-income 
women. 

Elaine Bratic Arkin 
Chair, Low-Income Subcommittee 
Healthy Mothers, Healthy Babies 
Coalition 



Low-Income Women Subcommittee* 
Healthy Mothers, Healthy Babies Coalition 



** Marilena Amoni, National Highway Traffic 
Safety Administration, U.S. Department of Trans- 
portation 

** Elaine Bratic Arkin, Public Health Service, 
U.S. Department of Health and Human Ser- 
vices 

Leslie Atkinson, National Dental Association 

Sallye Brown, Nurses Association of the Amer- 
ican College of Obstetricians and Gynecolog- 
ists 

** Joan Cooney, Department of Human Services, 
Arlington, Virginia 

Patricia Daniels, U.S. Department of Agriculture/ 
Food and Nutrition Service 

Doris Dvorscak, U.S. Department of Agriculture/ 
WIC 

Karen Ehrnman, American College of Nurse- 
Midwives 

Roselyn P. Epps, M.D., National Medical Associa- 
tion 

Ruth Gordner, Child Welfare League of America 

** Rae Grad, Ph.D., Southern Governors' Association 

** Dana Hughes, Children's Defense Fund 

Bob Hutchings, Office on Smoking and Health, 
U.S. Department of Health and Human Services 

** Kay Johnson, Children's Defense Fund 

** Lynn Jordan, U.S. Department of Agriculture/ 
WIC 

** Carole Kauffman, American Red Cross 

** Kim Kelly, National Center for Education in 
Maternal and Child Health 

** Morton A. Lebow, American College of Obstetri- 
cians and Gynecologists 

Julia Lockway, American Home Economics 
Association 

** Susan Lockhart, Division of Maternal and Child 
Health, U.S. Department of Health and Human 
Services 



Christine Lucas, Charles City County (Va) Health 
Department 

** Col. Edith MacLachlan, The Salvation Army 

** Lorraine Mastropieri, Eunice Kennedy Shriver 
Center (Massachusetts) 

** Jude McClure, National Clearinghouse for Alco- 
hol Information 

** Caroline McNeil, American College of Radiology 

** Karen Monaco, American Lung Association 

** Paula Pachon, National Clearinghouse on Alcohol 
Information 

** Louise Peloquin, March of Dimes Birth Defects 
Foundation 

Luz Porter, American Nurses Association 

Linda Redman, Association of State and Ter- 
ritorial Health Officials 

** Sally Roy, National Health Information Clearing- 
house 

** Dr. Margaret Scarlett, Centers for Disease Control 

** Emily Schrag, National Center for Clinical Infant 
Programs 

** Marion Slatin, ACYF Head Start 

Lucy Caldwell Stair, American Red Cross 

** Kathleen Stoll, National Health Law Program 

** Mary E. Sullivan, Health Care Financing Ad- 
ministration, U.S. Department of Health and Hu- 
man Services 

** Patricia Theiss, Community and Family Medi- 
cine, Georgetown University School of Medicine 

** Edith P. Thomas, Ph.D., U.S. Department of Agri- 
culture Extension Service 

** Jeffrey Tirengel, Executive Secretariat, Healthy 
Mothers, Healthy Babies Coalition 

** Paul Turner, Centers for Disease Control, U.S. 
Department of Health and Human Services 



'Addresses are listed in Chapter 13: Resources 
''Participation in survey development and review 



Additional Reviewers 



Writers 



Shirley Barton, National Highway Traffic Safety Ad- 
ministration 

J. Baumgarten, Centers for Disease Control 

Elizabeth Brannon, Division of Maternal and Child 
Health, U.S. Department of Health and Human Ser- 
vices 

B. Campbell, U.S. Department of Agriculture/FNS 

Nancy Chetry, U.S. Department of Agriculture/FNS 

Annette Crangle, D.C. Lung Association 

Joanne Gephart, Division of Maternal and Child 
Health, U.S. Department of Health and Human Ser- 
vices 

Judy Good, La Leche League 

Nancy Haliburton, Division of Maternal and Child 
Health, U.S. Department of Health and Human Ser- 
vices 

L. Hoyt, American Academy of Family Physicians 

Vince Hutchins, M.D., Division of Maternal and Child 
Health, U.S. Department of Health and Human Ser- 
vices 

Mary Jarman, Executive Secretariat, Healthy 
Mothers, Healthy Babies Coalition 

Anne Molofsky, U.S. Department of Agriculture/FNS 

Brenda Schilling, U.S. Department of Agriculture/ 

FNS 

M. Sloane, U.S. Department of Agriculture/FNS 



Elaine Bratic Arkin, Public Health Service, U.S. De- 
partment of Health and Human Services 

Christine Lucas, Charles City County Health Depart- 
ment, Charles City, Virginia 

Caroline McNeil, American College of Radiology 

Jude McClure, National Clearinghouse for Alcohol 
Information 

Patricia Masters, National Health Information Clear- 
inghouse 

Kathleen Stoll, National Health Law Program 

Mary Sullivan, Health Care Financing Administra- 
tion 



DDD 



How To Use 
This Report 



The Executive Summary on page ix identifies the ma- 
jor goals, common strategies, and needs of program 
respondents that emerged from the survey. 

Chapter 1 summarizes a series of 15 focus group inter- 
views held with Black and Mexican American 
Women, and subsequent interviews with their health 
care providers, concerning sources and needs for 
health information. This market research, the "Juarez 
Report," has been used to identify strategies, topics, 
and dissemination routes for Coalition-produced edu- 
cational materials. It is included as a reference for 
readers concerned with the information needs of these 
women. 

Chapter 2 is a review of the health education litera- 
ture addressing the low-income and minority pop- 
ulations, included to provide background to the survey 
findings. 

Chapters 3 through 12 summarize survey findings. 
The findings are categorized according to the service/ 
health care settings or type of educational programs 
that responded to the survey. Each summary chapter 
includes sections, where appropriate, on: 

characteristics of programs 

services and strategies 

staffing 

outreach 

educational programs 

needs for educational materials 

successes 

advice and observations 

To the extent possible, each chapter follows the same 
format to facilitate the use of this report by readers 
who want to scan particular sections (e.g., outreach 
strategies). 

Chapter 13 identifies other sources for information, 
educational materials, and programs related to mater- 
nal and infant health. 

The survey instrument is located in Appendix A. 
Appendices B and C describe services available 
through EPSDT and the National Health Law Pro- 
gram. These descriptions are included as resources for 
readers who seek ways to make services more avail- 
able to low income women. 



Finally, beginning on page 100, all survey respon- 
dents are listed by State. In addition to name and 
address, the codes listed below each phone number 
refer to program characteristics and kinds of women 
served (index to code is included on the bottom of every 
right-hand page). Every program cited in this text is 
listed in this section. Readers are encouraged to con- 
tact respondents with similar clients, programs, or 
problems to their own. 

We hope that this report will serve as a reference and 
referral point, and just a beginning to the sharing 
among those concerned with the good health of these 
high-risk women and their babies. 



DDD 



Executive 

Summary 



The Healthy Mothers, Healthy Babies survey con- 
ducted in spring 1985 drew responses from over 1,500 
programs active in maternal and child health efforts 
directed toward low-income women and their families. 
These programs were classified into 10 broad cate- 
gories, according to their major emphasis: 

• Prepregnancy Programs 

• Prenatal Services 

• Postnatal Programs 

• Comprehensive Programs 

• Breastfeeding 

• Nutrition 

• Substance Use During Pregnancy 

• Rural Populations 

• Native Americans 

• Adolescent Pregnancy 

To some extent, all of the programs are involved in 
activities that are related to most other areas. In addi- 
tion, they share an awareness of low-income women 
and their families as individuals. Three major goals 
emerged from the survey responses: 

• Commitment to helping low-income women have 
healthy infants and reach their full potential as 
mothers 

• Commitment to the physical well-being and emo- 
tional development of children born into low-income 
families 

• Commitment to supporting the total family to en- 
sure the participation of mothers and fathers as ac- 
tive, aware parents 

Also emerging were common strategies used to reach 
these goals: 

• Use of funding from a combination of sources — 
Federal, State, and local governments, and from pri- 
vate voluntary agencies and organizations 

• Reliance on informal support from community and 
voluntary agencies that frequently provide facilities 
for programs and sources of information and referral 
for potential clients 

• Use of volunteers in a wide range of roles to supple- 
ment professional and paraprofessional staff 



• Efforts to reach low-income families through aggres- 
sive, innovative outreach programs 

• Coordination with-other programs to avoid duplica- 
tion of effort and to increase contact with low-income 
families 

• Advocacy and education to ensure that women and 
their children receive the assistance to which they 
are entitled under Federal and local mandates 

Finally, the survey respondents articulated a number 
of "needs" to help them reach their goals: 

• Increased networking and coordination among pro- 
grams active in providing maternal and child health 
services 

• Increased participation of low-income families in the 
planning of programs 

• Need for printed and audiovisual materials targeted 
to specific groups, including Black, Asian, Hispanic, 
and low-income patients; respondents requested 
materials written at the 4th to 6th grade reading 
levels (or below) that are heavily illustrated; they 
asked that basic information (written and au- 
diovisual) be provided on the following topics: repro- 
ductive processes and family planning; labor and 
delivery; fetal and early childhood development, de- 
leterious effects of substances such as tobacco, alco- 
hol and drugs on the developing fetus; and nutrition 

• Need for professional, paraprofessional, and volun- 
teer education and training models, and effective 
methods for evaluating existing programs and avail- 
able materials. 



DDD 



HEALTHY MOTHERS MARKET RESEARCH 



l 



EXECUTIVE SUMMARY 
OF THE JUAREZ REPORT 



Healthy Mothers 
Market Research: 
How to Reach Black and 
Mexican- American Women 



OVERVIEW OF THE MARKET 
RESEARCH STUDY 

One phase of the Healthy Mothers, Healthy Babies 
campaign effort to communicate with women in high- 
risk target groups consisted of a market research 
study. Conducted by Juarez and Associates of Los An- 
geles, the study was undertaken in 1982 to support the 
development of better techniques and strategies for 
promoting health messages to women of lower socio- 
economic status (SES). In an effort to concentrate re- 
sources and prevent dilution of the effects of research 
variables, the study was limited to low-SES Black and 
Mexican-American women. The goals of this study 
were as follows: 

1. To identify credible sources of health information 
for women in the target audience; 

2. To explore the roles of family members with regard 
to health care, especially during pregnancy; 

3. To identify potential access points (e.g., media, 
community groups, and family members); 

4. To enumerate the health interests and needs of the 
target audience; 

5. To document the perceived barriers to seeking care 
and information; and 

6. To document cultural sensitivities that should be 
recognized in program development. 

The market research had three components: (1) an 
analysis of the target audience; (2) research with the 
primary target audience of low-SES Black and 
Mexican-American women; (3) research with a secon- 
dary target audience of health professionals. 

The target audience analysis, consisting primarily of a 
literature review, is summarized and updated in 
Chapter 2 of this compendium. The other two com- 
ponents and their findings are summarized here. 
Copies of the full report are available from the 
Healthy Mothers, Healthy Babies Coalition, 600 
Maryland Avenue, S.W., Suite 300E, Washington, DC 
20024-2588. 



METHODOLOGY 

Four locations were selected as study sites for market 
research with the primary target audience and with 
health professionals. The sites, selected to represent 
geographical dispersion, population sites, population 
density, and various ethnic/racial compositions, were 
Los Angeles, California; Chicago, Illinois; McAllen 
(Rio Grande Valley), Texas; and Selma (Dallas Coun- 
ty), Alabama. 

Research with the primary target audience consisted 
of 15 focus groups, eight with Black women and seven 
with Mexican- American women. Two age ranges were 
established between 15 and 22 years of age and be- 
tween 23 and 34, and within each focus group all of 
the women were the same ethnicity and in the same 
age range. Additionally, within the age and ethnic 
categories, separate groups were conducted with 
women who were currently pregnant and those who 
were not. Selected combinations of characteristics 
were represented in the four sites. Low SES was de- 
fined by the Department of Labor's guidelines which 
are based on annual household income and household 
size. Focus group participants were screened to ascer- 
tain that they met these criteria (a maximum income 
of $10,400 for a household of four). 

By definition, a focus group is a personal interview 
conducted simultaneously among a number of in- 
dividuals. Unlike in-depth interviews, which are an- 
other form of qualitative research, focus groups rely 
more on group discussion than on a series of directed 
questions to generate data. The goal of these focus 
groups was to explore women's present knowledge and 
sources of prenatal care, to examine the application 
and usefulness of educational materials, to identify 
information and services that are available, and to 
arrive at techniques that might be used to motivate 
these women to assume greater personal responsibil- 
ity for their health and that of their infants. 

Information from the secondary target audience — the 
health care providers for these women — was compiled 
through a variety of structured data collection 
methods, including mail, telephone, and personal con- 



HEALTHY MOTHERS MARKET RESEARCH 



tacts. Comparable information on a series of topics 
was received from 163 health workers who had been 
identified as spokespersons within the community 
health delivery system of each of the four sites. Like 
focus group participants, health providers were 
selected as informed respondents who were 
knowledgeable and could relate experiences of the 
group they represent. 

Information from this secondary target audience was 
sought for two reasons: (1) to gain an additional per- 
spective on the health interests and needs of low-SES 
minority women, on the barriers that such women 
encounter in attempting to obtain health care and 
information, and on the importance of cultural in- 
fluences on health care attitudes and behavior, and (2) 
to examine the availability and adequacy of the health 
information materials and techniques that are cur- 
rently used or recommended by health professionals. 

Limitations on the findings and the conclusions that 
can be drawn from this market research study are 
those associated with qualitative methods: the re- 
search is subjective in the sense that it involved 
obtaining information about feelings and impressions 
from small numbers of respondents, information that 
usually cannot be quantified in numerical terms; and 
conclusions reflect general trends that do not account 
for all the individual variations in responses. Addi- 
tionally, women who participated in the focus groups 
had some familiarity and experience with the health 
care system and therefore some motivation toward 
seeking health care. 

CONCLUSIONS AND RECOMMENDATIONS 

Conclusions that can be drawn from the three com- 
ponents of the market research study have been or- 
ganized around topics related to the study's objectives. 
Recommendations are presented regarding special 
considerations for message development and im- 
plications of the findings for program development. 

1. Credible sources of health information 

Social networks. The literature review suggested 
that because lower socioeconomic minorities tend to be 
ethnocentric and isolated from influences that reach 
White Americans and groups of higher socioeconomic 
status, the family and friendship network is the domi- 
nant influence on health behavior and the most cred- 
ible source of health information for poor, minority 
women. Responses from health professionals sup- 
ported this finding. They stressed that the family often 
encourages a woman to follow traditional practices 
and that family and friends provide misinformation 
that contradicts the advice of the physician and re- 
duces the credibility of health professionals.* 

Physicians. Although focus group participants re- 
ported that they depend on their families for informa- 



tion (particularly on their mothers**), they regard 
physicians as the most credible source for medical 
information. However, women in the focus groups fre- 
quently indicated that they do not consider most pre- 
natal care issues as problems requiring medical in- 
formation. Also, the women felt their doctors were 
often inaccessible to them. They reported that doctors 
do not seem to have time to talk with patients; some 
said they do not know what to ask their doctors and, 
not wanting to appear ignorant, they ask their 
mothers instead. 

Mothers. Mothers are generally regarded as the most 
credible source for subjective aspects of pregnancy 
(such as whether delivery will be painful) and are 
more likely to be consulted about minor ailments or 
discomforts than doctors. Also, mothers are generally 
accessible and are often sought for information as a 
substitute for doctors. 

Nurses. Nurses were cited by both health care pro- 
viders and focus group participants as the primary 
conduit for information in clinic settings. However, 
nurses were rated by the focus group participants as 
having less credibility than either physicians or 
mothers. Nurses lack the professional authority of 
physicians (for these women) and are associated with 
many of the negative aspects of the clinics — long 
waits to see the doctor, indifferent and often critical 
attitudes of the staff, and difficulty in negotiating the 
clinic system (e.g., uncertainties about proper forms 
and procedures, language barriers). 
Pharmacists. While mentioned in the literature as a 
potential information source for Mexican-American 
women, pharmacists did not seem to be viewed as 
particularly credible sources by the Mexican- 
American women in the groups; they felt that doctors 
would be better informed and more trustworthy than 
pharmacists. 

Television. This was the only broadcast or print 
medium that focus group participants mentioned as 
having a high level of credibility for them. Urban 
Black participants frequently recalled specific pro- 
grams — documentaries, "For Your Information" 
("FYI"), and soap operas, but not public service an- 
nouncements — that had revolved around health 
issues. They said they enjoyed these programs and felt 
that the information received has had an effect on 
their practices. The visual impact of television was 
specifically mentioned as the reason for its high credi- 
bility; the only reservation that was stated about 
television was the predominantly White middle class 
orientation of most programs. Mexican-Americans 
said that they were interested in television as an in- 
formation source, specifically mentioning a soap 



* Health care providers emphasized the influence of the family for Mexican-Americans and 
that of mothers, grandmothers, and friends for Blacks. 

** The term "mother" is used in this context as a proxy for any older or more experienced 
woman who holds a position of respect or authority for the pregnant woman. 



HEALTHY MOTHERS MARKET RESEARCH 



opera-type program originating from Mexico, but the 
scarcity of Spanish-language programs decreases its 
importance for them. 

2. Roles Played by Family Members Regarding 
Health Care and Information 

Although responses from health care providers 
emphasized the importance of the pregnant woman's 
social network as a source of health information, focus 
group participants were divided with regard to the 
role of family and friends as sources of information. As 
discussed, the mother (or mother figure) tends to be an 
important and highly credible source. Peers were 
mentioned primarily as providing information on 
health services rather than advice or information on 
health practices. The women in the focus groups were 
particularly ambivalent about the role of the baby's 
father (or current male partner); although the father 
may be involved in decisions regarding prenatal care, 
he is not considered to be a good source of information 
because he lacks knowledge about childbirth and a 
woman's anatomy. 

Emotional support. Focus group participants did not 
seem to consider the primary role of family and friends 
to be health education; instead, they felt their impor- 
tant function during the pregnancy is to provide 
general and emotional support. General support 
might involve the transportation of the woman to 
medical facilities, caring for other children, and help- 
ing the woman negotiate the health delivery system 
(English/Spanish translating was mentioned fre- 
quently by Mexican- American women). The emotion- 
al support provided by family and friends was seen as 
even more important. Repeatedly, the existence of a 
social network was mentioned as having positive con- 
sequences for a woman's emotional state — and as 
directly or indirectly affecting a woman's physical 
well-being. Women in the focus groups reported that 
they were more likely to stop smoking and eat bal- 
anced meals if encouraged to do so by their male part- 
ners (or, in his absence, their own mothers or grand- 
mothers). 

Baby's father. A current relationship with the baby's 
father seemed especially important as a motivation to 
adopt good health practices. While the father was not 
generally perceived as a good source of health in- 
formation, his presence, emotional support, and in- 
fluence were reported to have considerable impact on 
the mother's state of mind and on her assimilation and 
use of the information she received from other sources. 
Urban Black women, in particular, were very ex- 
pressive of their emotions and tended to cite feelings of 
loneliness and isolation during pregnancy as reasons 
for not following sound health practices. 

Cultural differences. Health care providers general- 
ly agreed with the literature that Mexican-American 



women were more likely than Black women to have 
strong family networks and the presence of a male 
partner. It appeared that this generalization held true 
within the focus group context; more of the pregnant 
Black women appeared to be without male partners 
than did the Mexican-American women, and more of 
the Black women stated that they had been without 
partners during previous pregnancies. Urban Black 
women also complained that they had to attend pre- 
natal clinics alone while Mexican-American women 
seemed to be accompanied frequently by family. 

Mexican-American women in the focus groups were, 
in general, more reluctant and less likely than Black 
women to initiate a discussion of their emotions or the 
psychological aspects of pregnancy. Instances in 
which this generalization did not hold true, however, 
occurred among pregnant Mexican- American women 
who reported themselves isolated from their families 
— either by physical distance or the rejection of the 
woman by her family because she was pregnant and 
not married. 

3. Potential Access Points for Dissemination of 
Health Information 

Public health clinics. Both health professionals and 
women in the focus groups cited the public health 
clinic as the best access point for prenatal health in- 
formation. Individual counseling with the doctor or 
nurse, prenatal classes, films or video cassettes, and 
written materials (generally in that order) were rated 
by both respondent groups as the most effective means 
of disseminating information. While responses from 
health care providers indicated that facilities provide 
health information on a variety of topics and use most 
of these methods, many individual health pro- 
fessionals agreed with the assessment of the women in 
the focus groups that the typical clinic setting is in- 
adequate in terms of its procedures, the attitude and 
knowledge of staff, and the materials that are used. 
The following criticisms and recommendations 
emerged from both groups: 

Clinic waiting period. Waiting areas in clinics are 
bleak, unattractive, and overcrowded; waiting periods 
to see a doctor or nurse are long and the focus group 
participants indicated that any information given 
during this time would be read or watched eagerly. 
The presence or absence of a male partner was not 
posed as an issue during the focus groups but frequent- 
ly emerged from the discussion. 

Health professionals also recognized that the waiting 
period is the best time to disseminate information but 
that clinics have inadequate staff to provide intensive 
patient education. 

Counseling. Individual counseling was considered 
the best method of disseminating information if the 
health professional can establish rapport with the 



HEALTHY MOTHERS MARKET RESEARCH 



patient. Health provider respondents frequently in- 
dicated that one-to-one counseling is rushed because 
of the large number of patients; women in the focus 
groups complained also that they feel rushed in their 
encounters with doctors and nurses and don't feel that 
they receive enough information from either source. 
Sometimes communication difficulties result from the 
fact that the staff and patients may speak different 
languages; most frequently, women in the focus 
groups stated that they are hesitant to ask questions. 
The reluctance of patients to participate in the group 
discussions was mentioned by health professionals 
who also indicated that the quantity and scope of in- 
formation given depends often on the persistence of 
the patient and the caseload of the clinic. 

Education. Prenatal education classes were consid- 
ered effective by health providers and respondents in 
focus groups. Women remembered specific informa- 
tion they had learned in the classes and agreed with 
the health professionals that classes were best when 
scheduled during the waiting period rather than at 
times that require additional trips to the clinics. 
Health providers indicated two concerns: one, the lack 
of staff to conduct classes; two, insufficient materials 
— written and audiovisual materials, films and equip- 
ment, and lesson plans. 

Staff attitudes/knowledge. In addition to state- 
ments that staff members spend little time with each 
patient, both health care respondents and focus groups 
participants felt that the staff was often hostile and 
judgmental toward patients. Health care pro- 
fessionals indicated that staff often lacks appropriate 
language skills, but — more critically, in their opin- 
ions — staff members are insensitive to the patients' 
limited social, educational, and economic resources, 
and their cultural backgrounds. Recommendations by 
health professionals included the hiring of additional 
Spanish-speaking staff and the training of present 
staff with regard to the difference in backgrounds and 
perspectives between patients and clinic staff. Specif- 
ically mentioned in this context were dietary prac- 
tices, lack of future orientation or long-range planning 
among patients, and the traditional decision-making 
role of husbands in the Mexican-American culture, 
and mothers or grandmothers in the Black culture. 

Information materials. Use of films and videotape 
cassettes in clinics was recommended by both health 
care providers and women in the focus groups. Health 
professionals felt such materials are most effective in 
a class situation, but indicated they do not have suf- 
ficient films and equipment and, when available, films 
are sometimes inappropriate for their patients. (For 
example, the films depict a White middle-class woman 
with a husband, their language is too technical, and 
there is no Spanish-language version.) Some pro- 
fessionals felt that women pay little attention to films 
shown in waiting rooms. Focus group participants dis- 



agreed and stated they would be interested in any kind 
of information while they were waiting — especially 
films. 

Although they complained of insufficient quantities 
and inappropriate written materials as well as films, 
many health providers felt that written materials are 
effective only to reinforce information given orally. 
Black focus group participants, more interested in as 
well as more familiar with pamphlets than Mexican- 
American women, criticized the unavailability of 
reading materials and insufficient variety among 
pamphlets in clinics; they like pamphlets, as opposed 
to books or posters, because they can take them home, 
but cautioned that only women already interested in a 
specific topic were likely to read pamphlets. Both 
health providers and focus group respondents recom- 
mended several ways that written materials could be 
improved: 

• They need to be attractive, easy to understand, 
short, and preferably colorful. 

• Technical jargon, complex concepts, and language 
requiring good reading skills should be eliminated. 

• Photographs or line drawings should be used abun- 
dantly, but must reflect the ethnicity and lifestyle of 
the patients (for example, the existence of a spouse or 
two -parent family should not be assumed). 

• Symbols, such as food or traditions with which the 
patients are familiar, should be used; stereotyping 
must be avoided (for example, some health pro- 
fessionals suggested that the use of serapes and 
mariachis, as symbols, is offensive to some Mexican- 
Americans). 

• Stories or a comic book format were recommended by 
health care professionals. 

Outside clinic settings, the following potential access 
points were mentioned: 

Women, Infants and Children Program (WIC) 
staff. Among focus group participants, the Federally- 
funded WIC program was frequently mentioned; most 
women had had direct contact with WIC and indicated 
a high regard for the program's staff and services. 
Advice on many aspects of prenatal care as well as food 
products and referrals for health services had been 
obtained through WIC community workers. Health 
providers often cited the impact of WIC's outreach 
efforts on the number of patients referred to clinics for 
prenatal care and mentioned the use in clinics of in- 
formation materials developed and supplied by the 
program. 

Trained lay persons. Health professionals and rural 
focus group participants suggested that older or re- 
spected community women be trained to inform 
women about the availability and need for prenatal 
health care. Other recommendations by health care 
providers were to include spouses and family members 



HEALTHY MOTHERS MARKET RESEARCH 



in prenatal education classes and to organize groups of 
community women or clinic patients to discuss their 
immediate needs and concerns, integrating health in- 
formation into the discussion only as appropriate. 

Schools. Schools were viewed by health providers and 
women in the focus groups as an appropriate setting 
for prenatal health education because schools have 
access to the young in an educational environment. 
Both groups concurred, however, that the school sys- 
tem appears uninterested in prenatal health issues 
and is currently doing a minimal amount of health 
education. 

Churches. Churches were not considered an effective 
channel for disseminating health information by 
either focus group participants or health care pro- 
viders. Women of the target audience indicated that 
churches displayed a judgmental and often hostile 
attitude about prenatal issues; and they attended 
church for spiritual reasons and were not interested in 
health information through this source. 

Television. Television programs, both documentaries 
and dramas, were suggested by focus group members 
as a good access point. Black women, in particular, 
indicated that they enjoy learning about health issues 
through television, and "FYI" was specifically men- 
tioned in many of the groups as a good information 
source. Mexican-American women tended to see 
television as a less valuable health information 
source, primarily because of the scarcity of Spanish- 
language television programs. 

Radio. Focus group participants said they view radio 
programming as generally inconsequential in the dis- 
semination of health information. Some health pro- 
viders mentioned radio programming as a potentially 
effective communication medium, but primarily 
either for reaching Spanish-speaking populations or 
in the rural areas where other media and the use of 
outreach workers are limited. 

4. Health Interests and 
Needs of the Target Audience 

There was no agreement among health providers 
about the specific types of information needed by low- 
socioeconomic women; many respondents simply 
stated that their patients need information on all 
topics related to prenatal health care. Other health 
professionals felt that patients do not lack information 
as much as they lack the social and economic resources 
— and in some cases, the motivation — to use the 
information. Still other respondents expressed their 
frustration about not knowing what types of informa- 
tion their clients want or need because their patients, 
despite repeated encouragement by clinic staff, tend 
not to ask any questions; Mexican-American women 
were mentioned specifically as being extremely re- 
served although they appear interested when clinic 



staff discuss various topics with them. Topics men- 
tioned by health providers as those about which their 
patients seek information (although not necessarily 
the ones about which they most lack or need informa- 
tion) primarily related to issues of comfort or the dis- 
ruption of normal routines (for example, the minor 
discomforts and physical changes of pregnancy, the 
ability to engage in sex or continue working during 
pregnancy). 

Among focus group participants, several themes 
emerged that relate to their health interests and need 
for health information: 

• Women in the focus groups demonstrated familiar- 
ity with the general guidelines for prenatal health: 
they could frequently state the need to avoid smoking, 
using alcohol, and taking medications; they could 
name the advantages of breastfeeding over bot- 
tlefeeding; they could list the food groups to be in- 
cluded in a pregnant woman's diet; they often in- 
dicated the value of exercise and the importance of 
visits to the doctor. 

• Although members of the groups discussed the risks 
for the baby associated with ignoring these guide- 
lines, they generally felt that poor health practices 
would impact more on the mother's health than on the 
baby's health. 

• Most of the women indicated that they did not com- 
ply with most of the recommended health practices 
and, essentially, had not altered their health practices 
in any way during their pregnancies. 

• Although both Black and Mexican-American 
women in the focus groups indicated some disbelief in 
the stated consequences of noncompliance with the 
recommended health behavior, the general reasons 
given for not altering their health habits during preg- 
nancy tended to vary between the two groups of 
women. Mexican-American women most frequently 
cited two difficulties involved in modifying their 
habits: the influence of either their immediate family 
or traditional practices (for example, their husband's 
reluctance about their being examined by a male doc- 
tor) or the effects of limited economic resources and 
support services (such as not being able to continue 
breastfeeding due to the need to work). Black women, 
on the other hand, were more likely to give personally 
oriented reasons for ignoring health recommenda- 
tions. They particularly emphasized the emotional 
stress of pregnancy (e.g., feeling bored, isolated, or left 
out of normal activities) and its relationship to in- 
dulgence in such practices as smoking, drinking, or 
overeating. They also stated that they had ex- 
perienced no ill effects during previous pregnancies 
when they had ignored the guidelines. And they said 
that any change in a pregnant woman's habits should 
be avoided because it was a form of "overprotecting" 
the baby. 



HEALTHY MOTHERS MARKET RESEARCH 



5. Perceived Barriers to Obtaining Health Care 
and Information 

Barriers identified by health care providers and focus 
group participants — and supported by the findings of 
the literature review — centered around three general 
issues: the low priority of preventive health care 
among the target audience; difficulties encountered 
within the health system; and the low motivation of 
women to modify their behaviors and adopt good 
health practices during pregnancy. 

Low priority of preventive health care. Women in 
the target audience (like members of other groups that 
are poor, uneducated, and socially isolated) are lim- 
ited in the social, economic, and personal resources 
available to them. Priorities of obtaining food and 
shelter and caring for their families override the im- 
portance of seeking prenatal care. Often, women in the 
target audience only seek health treatment when 
physical symptoms are acute; pregnancy, viewed as a 
natural state, is not perceived as requiring medical 
intervention unless complications arise or arrange- 
ments for delivery must be made. Health care pro- 
viders confirmed this perception that the target audi- 
ence places a low priority on preventive health care 
but some offered their opinions that government and 
other funding sources also put a low value on pre- 
ventive health care for this group which, from their 
perspective, is reflected in the resources allocated to 
any form of preventive health service. 

Difficulties encountered within the health care 
system. Many of the difficulties encountered by 
women have been mentioned in previous sections of 
this chapter. The primary factors emerging from this 
study seem to be, first, communication barriers be- 
tween clinic staff and patients (including lack of time 
for individual counseling of patients, perceived nega- 
tive attitudes of staff, insufficient Spanish-language 
skills of staff, perceived reticence or passivity of the 
patient); and second, the unavailability or in- 
appropriateness of materials and methods of informa- 
tion dissemination (such as the lack of sufficient 
Spanish-language materials, the predominately 
middle-class orientation and high reading level of 
most materials). 

Low motivation to adopt good health practices. 

The generally low motivation of low-SES minority 
women to modify their health behaviors during preg- 
nancy was stated by many health providers and con- 
firmed by focus group participants (although it was 
less likely to be emphasized as an important issue in 
health behavior by Mexican-American women and by 
health professionals who work with this group). Three 
factors were frequently mentioned in connection with 
low motivation: 

• The target audience has a predominantly day-to-day 
orientation; consideration of the effect on the baby of 



their health habits during pregnancy is too abstract 
and long range for this group. 

• Assimilation of health information often requires 
women to change long-standing habits and practices; 
these modifications may be neither understood nor 
supported by family and peers. 

• Other life problems, including emotional stress, may 
take priority over health care during the pregnancy; 
in the focus groups, most urban black women (and, to a 
lesser extent, urban Mexican-American women) were 
considerably more interested in discussing issues re- 
lated to mental health than those related to physical 
health. 

6. Cultural Sensitivities 

to be Recognized in Program Development 

One object of this study was to document sensitivities 
that need to be recognized in program development, 
but the findings from all three components of the re- 
search do not clearly indicate any specific cultural 
sensitivities of the target audience. 

Differences among cultures. The majority of health 
provider respondents stated that there are many fac- 
tors related to the cultural background of their clients 
that need to be considered in the preparation of mate- 
rials and the dissemination of information. However, 
the factors that they tended to cite do not relate to the 
culture; they relate to common issues for all members 
of groups that are largely poor, uneducated, and 
socially isolated rather than specifically to either the 
Black or Mexican-American culture. The primary 
cultural consideration in communicating health in- 
formation, according to the providers and the focus 
group respondents, appears to be a knowledge and 
appreciation of differences among cultures. Examples 
of specific issues that were mentioned are the tradi- 
tional dominance of the male in the Mexican- 
American family, food habits that are culturally 
specific, and possible belief in folklore or use of tradi- 
tional remedies. 

Mexican-Americans' diversity. One point that 
emerged from the focus group discussions was the 
difference between the individual members of the eth- 
nic group. There was great diversity in both urban and 
rural areas among participants in the Mexican- 
American focus groups, particularly related to levels 
of education, acculturation, and language skills. This 
diversity is supported by the literature review finding 
that Mexican-Americans, as a group and as in- 
dividuals, are in a state of transition. 
Folk beliefs. Among Mexican-Americans, those in- 
dividuals who are the least acculturated into Amer- 
ican society appear to be the most sensitive about 
discussing traditional health practices and beliefs. 
Rural Mexican- American focus group participants ex- 
hibited considerable sensitivity and reluctance to dis- 



HEALTHY MOTHERS MARKET RESEARCH 



cuss topics which suggested that their values or health 
practices were traditional (equated, for them, with 
"backward" and "old-fashioned"), and not modern and 
Americanized. This sensitivity about the application 
of traditional notions or stereotypes was also ex- 
pressed, but more infrequently, in urban Mexican- 
American groups. Urban Black women were not 
generally familiar with traditional health practices; 
rural Black women repeated many folk precautions 
and a number of women said they followed these prac- 
tices. However, most focus group participants (Blacks 
and Mexican-Americans in rural and urban areas) 
exhibited no confusion between folklore and medical 
information; folk beliefs, when followed, appeared to 
be superstitious behavior that did not conflict with 
acceptance of health information. 

IMPLICATIONS FOR PROGRAM 
DEVELOPMENT 

• There is a need for health information campaigns to 
emphasize motivational appeals. Low-SES women 
were familiar with the general guidelines for prenatal 
care, but frequently did not follow these recommended 
health practices. Also, there was little recognition of 
the link between the mother's behavior and its impact 
on the baby's health. It is important to remember, 
however, that these women are more concerned with 
immediate needs than issues requiring long-range 
planning — and 2 to 3 months is often considered a 
long-range time frame. 

• Women of the target audience primarily were inter- 
ested in the psychological or psychosocial issues of 
pregnancy, such as how to cope with emotional 
stresses and the effects that pregnancy will have on 
their everyday lives. They are concerned also with 
issues related to comfort and appearance. Themes 
should be developed that address these issues and, 
secondarily, relate information about other prenatal 
health topics. 

• Emphasis should be placed on the public health 
clinic as the primary point for the dissemination of 
health information because (1) women who are in the 
clinics are already interested in health care; (2) they 
are accessible; and (3) they have time while waiting 
for appointments to listen and participate in health 
education. 

• Priority should be given to methods of dissemination 
in this order: (1) individual counseling; (2) prenatal 
education classes; (3) audiovisual materials. Written 
materials are the least effective of the most common 
clinic education methods. Their primary value is that 
they can be taken home to serve as a reference and 
reinforcement for information transmitted through 
other methods. 

• Physicians need to be trained in counseling skills 
because they have the most credibility as a health 



information source but are often perceived as inaccess- 
ible and unwilling to discuss the concerns of patients. 
Since clinic physicians do have limited time with each 
patient, techniques are needed to make counseling as 
easy as possible for the doctor. 

• Nurses also need to be trained in effective, yet 
simple, counseling techniques because they are the 
primary source of health information in clinics. 
Unlike physicians, they had relatively low credibility 
for low-SES women. Material prepared should include 
an emphasis on the need for clinic staff to understand 
that low-SES women lack communication skills and 
have limited economic and social resources. 

• Health providers frequently did not know what 
types of information their patients need because 
patients are hesitant to ask questions. Effort should be 
directed at developing materials to assist the patient 
to feel able and comfortable to communicate her needs 
to clinic staff. 

• Audiovisual and written materials currently avail- 
able in clinics were criticized because (1) women could 
not comprehend them; and (2) the materials did not 
reflect the women's personal life situations. Concerns 
regarding the required level of language skills, the 
complexity of the concepts, and the appropriateness of 
the presentation need to be considered in the future 
development of materials. 

• A model and channel for effective community out- 
reach to low-SES women already exists in the WIC 
program. This program should be supported and ex- 
panded. WIC health workers were highly visible to 
low-SES women in both rural and urban areas. They 
were well respected and provided health information 
as well as referrals for health care. WIC workers are 
more credible than other health professionals because 
(1) they are identified with the community; (2) they 
contact women in settings which are more familiar 
and comfortable for the women than medical facilities; 
and (3) they are associated with providing products 
and services related to the immediate needs of the 
women. 

• Of the mass media, only television programs (but not 
public service announcements) were found to have 
influence on the health behavior of low-SES women — 
and only for Black women. 



SPECIAL CONSIDERATIONS 
FOR MESSAGE DEVELOPMENT 

The findings of the study suggest that the following 
issues should be considered in the development of mes- 
sages for the target audience: 

• The male partners and mothers of low-SES women 
could be a secondary target audience for health in- 



HEALTHY MOTHERS MARKET RESEARCH 



formation messages because; (1) they have a strong 
influence on the women's health behavior; (2) they are 
highly credible sources of health information as well 
as the source of misinformation; and (3) they can pro- 
vide emotional support to the women, which has a 
positive effect on adoption of good health practices. 

• Black and Mexican- American women were familiar 
with folk beliefs and traditional practices, but there 
appeared to be little conflict between knowledge of 
folklore and the acceptance of health information. Be- 
cause these beliefs are familiar to the target audience, 
they represent possible themes for the development of 
appeals and materials. For example, the adage that 
"too much rest will cause the baby to stick to you and 
might cause a difficult delivery" (se te pega el nino, in 
Spanish) might be a departure point for a message on 
the value of exercise. 

• Mexican-American women, as individuals and as a 
group, are in a state of transition; they exhibit a wide 
range of individual variation in terms of education, 
language skills, and acculturation. Information 
appeals directed at Mexican-American women might 
consider segmentation of this audience and all themes 
and materials should be carefully pretested. 

• Mexican- American women who are the least accul- 
turated tended to regard discussions of folklore and 
traditional health behavior as a potential source of 
embarrassment. They are sensitive to any suggestion 
that they value health practices related to the Mex- 
ican culture, which they view as possibly conflicting 
with health behavior associated with the American 
culture. 

• Urban Black women indicated that modification of 
their health behavior during pregnancy might be 
equated with coddling or spoiling the baby and, hence, 
be undesirable. This belief needs to be recognized in 
message development — especially messages focusing 
on the effect of the mother's behavior on the baby's 
health. 



DDD 



HEALTH EDUCATION FOR LOW-INCOME GROUPS 



2 



Health Education 

for Low-Income Groups: 

A Review of the Literature 



Do recent studies throw any light on the best ways to 
reach pregnant, low-income women? Although few ad- 
dress this issue directly, many cast light on it from one 
angle or another. This chapter reviews the recent 
literature relating to health education for low-income 
groups and provides a bibliography. 

Frequent references will be found in this chapter to 
the Juarez report of 1982. When the U.S. Public 
Health Service contracted with Juarez and Associates 
of Los Angeles to conduct market research for the 
Healthy Mothers, Healthy Babies campaign, the con- 
sulting firm's first step was a literature review. This 
paper is intended to update that review, but it casts a 
wider net over a shorter time period. While the Juarez 
review covered the literature of the previous decade, 
the current review covers reports appearing in or after 
1980, on health education or prenatal care for any 
low-income group. Reports reviewed include journal 
articles, books, dissertations, conference papers, and 
government reports. 

The Juarez report itself is important in the literature, 
being one of the few studies since 1980 that deals 
specifically with prenatal health education for low- 
income women. The findings of its focus group study 
are mentioned frequently and should not be confused 
with the findings of its literature review. 



BACKGROUND STUDIES 

There is no lack of reports documenting the im- 
portance of prenatal care and education. Prenatal care 
improved pregnancy outcome among women enrolled 
in publicly funded programs in North Carolina (Peo- 
ples, 1983), in Washington, D.C. (Rahbar, 1982), in 
Cleveland (Sokol, 1980), in Georgia (Spritz et al., 
1983), and in low-income Kansas women (Ryan, 1984). 
Childbirth education classes for high-risk, indigent 
women in Atlanta appeared to make a significant dif- 
ference in their attitudes toward childbirth (Zachar- 
ias, 1981). Prenatal breastfeeding education was effec- 
tive in a Chinese community in Canada (Chan- Yip, 



1983) and in a midwest community (Wiles, 1984). A 
report on American Indians found that, in contrast to 
the general population, they have less prenatal care 
and a higher incidence of newborn problems (Sullivan, 
1983). Among adolescents (Taylor, 1984; Levy, 1983; 
Neeson, 1983), the findings are similar: prenatal care 
and prenatal education improve pregnancy outcome. 

One study addressed the cost effectiveness of prenatal 
counseling. Orstead et al. (1985) found that intensive 
nutrition counseling helped prevent low birthweight; 
women who received multiple counseling sessions 
gained more weight and had fewer low birthweight 
infants than women who attended a nutrition class 
only. Moreover, when the cost of intensive neonatal 
care for six infants was compared to the cost of 
nutrition counseling, a benefit-to-cost ratio of 1:5 was 
found. 

When it comes to the question of how best to provide 
prenatal care and education to low-income women, the 
literature is not so clear. Relevant studies fall into 
three main categories — sources of health information 
for low-income and minority groups, motivations for 
seeking and barriers to prenatal care, and com- 
munication strategies for reaching low-income 
groups. The discussion that follows is organized under 
these three headings. 



SOURCES OF HEALTH INFORMATION 

These fall into four categories: the mass media, social 
networks, folk medicine, and health care providers. 
Most studies suggest that television and radio are 
important sources of health information and that 
family, friends, and traditional beliefs are of secon- 
dary importance. 

Mass media. The Juarez literature review found that 
the broadcast media and minority-specific media (e.g. 
Spanish radio and television stations) enjoyed a large 
audience and were probably the likeliest vehicles for 
health education. Studies since then tend to confirm at 
least the first finding — that radio and television are 
prime sources of entertainment and information for 



HEALTH EDUCATION FOR LOW -INCOME GROUPS 



low-income groups. A study based on interviews with 
35,000 women, a sample representative of women in 
the contiguous United States, found that a large pro- 
portion of those of low socioeconomic status (SES) were 
exposed to broadcast media, and that they were ex- 
posed at all times of the day (Chilton Research Ser- 
vices, 1982). Similarly, a study of knowledge of car- 
diovascular risks (Gombeski, 1981) found that the 
poorly informed groups, which were more likely to be 
of low socioeconomic status, rated television as a good 
source of health information. 

However, there is some disagreement over the value of 
minority-specific media. Greenberg et al. (1983) found 
that Spanish youth, who watched an average of 7 
hours of television and listened to 2 hours of radio a 
day, showed little interest in Spanish stations. His- 
panic adults in the same community expressed a pref- 
erence for Spanish media, however (Burgoon, 1983). A 
commercial marketing study adds evidence to this 
indication of a generation gap, reporting that older, 
married, and less educated Hispanics prefer Spanish- 
language radio while their younger, unmarried, and 
better educated children listen more frequently to 
English-language radio (O'Guinn, 1984). It is interest- 
ing to note that the number of Spanish-language radio 
and TV stations is increasing; in 1985 there were 
expected to be 80 full-time radio stations, 20 full-time 
TV stations, and 2 national Hispanic TV stations 
(Shields, 1984). 

The Chilton study (1982) helped fill in details about 
the mass media habits of low-SES women. It found, for 
instance, that many low-income women not only 
watch television but also read magazines, primarily 
Sunday, a magazine supplement appearing in many 
Sunday newspapers, and TV Guide* The pregnant 
women interviewed were more likely to watch TV 
than listen to the radio; they also watched daytime 
TV. A large proportion of black women read Sunday 
newspapers. Other detailed information emerged 
from the Juarez focus groups, where participants re- 
ferred frequently to the television program called 
"FYI" as well as to dramas and documentaries as be- 
ing sources of information. 

Social Networks. Much of the literature of the 1970s 
stressed the importance of family and friendship net- 
works as sources of credible health information for 
minority groups. The women in the Juarez focus 
groups did not agree. The primary role of family and 
friends for these groups of women was to provide 
general and emotional support, including help in 
negotiating the health care system. Except for 
mothers who were trusted as sources of information on 



* The ten most popular magazines according to the Chilton study were, in order of 
popularity: TV Guide, Reader's Digest, Better Homes and Garden, Good Housekeeping, 
Family Circle, Woman's Day, McCall, People, Sunday, Ladies Home Journal. 



the more subjective aspects of pregnancy , family mem- 
bers and friends were given little credence. 

Recent literature includes reports on both sides of this 
question. Gombeski's data (1981), gathered through a 
community survey, shows lower-income respondents 
rating family and friends as poor sources of health 
information and even poorer sources of credible health 
information. On the other hand, a survey of Asian- 
Americans (Ito, 1981) found that friends and relatives 
were considered important sources. Supporting this 
view is a report by the American Hospital Association 
(1982), based on a literature review and interviews 
with health professionals, cultural centers, and in- 
dividuals belonging to four cultural groups. This re- 
port, which is also an extensive resource guide, 
emphasizes that social networks are extremely impor- 
tant influences on the health behavior of Hispanics, 
Blacks, Asian-Americans, and American Indians. 

Folk Beliefs. Folk beliefs received much attention in 
the literature of the 1970s, and the Juarez literature 
review suggested that folk beliefs were strong among 
Mexican-Americans and rural Blacks. The American 
Hospital Association report (1982) agreed. Snow 
(1983) also found evidence of strong folk beliefs among 
Blacks, bolstered by a distrust of the majority culture 
and a hostile environment. Other literature of the 80s 
has concerned Indochinese refugees and their health 
beliefs (Muecke, 1983; Smith-Santopietro, 1981; 
Chong, 1984). 

But other data cast doubt on the significance of folk 
beliefs. Women in the Juarez focus groups did not 
emphasize their importance; these sayings and prac- 
tices seemed to be recognized as superstitions and did 
not appear to actually interfere with modern medical 
advice. In a study of low-income Puerto Rican and 
White women in Cleveland, Lazarus (1984) found that 
although Puerto Rican women retained a strong cultu- 
ral identity, prenatal care practices did not differ be- 
tween the two groups. Supporting this view, a study of 
Indochinese refugees (Falvo, 1983) suggests that west- 
ern medicine is viewed as complementing their home 
remedies, not conflicting with them. Studies of Navajo 
(Steward, 1980) and Zuni Indians (Camazine, 1980) 
also conclude that folk beliefs coexist with and may 
complement orthodox medicine, but do not displace 
modern medical advice. 

Health Care Providers. The Juarez focus groups 
revealed that health professionals, although often 
seen as inaccessible, were highly regarded as potential 
sources of health information. This finding is con- 
firmed by Gombeski (1981) who reported that low-SES 
individuals named physicians and clinics as their 
most frequent and most credible sources of health in- 
formation. Ramirez (1981) also found that Mexican- 
Americans and Anglos in Houston regarded doctors as 
the most reliable source. A large majority of those 



10 



HEALTH EDUCATION FOR LOW-INCOME GROUPS 



surveyed said they would be more likely to read an 
educational brochure if a doctor gave it to them or if it 
were mailed to them by a credible health agency. 

But the view of the physician as a source of informa- 
tion may be an abstract concept, the Juarez report 
suggests, because low-SES groups have infrequent 
contacts with physicians. One study indirectly sup- 
ports this suggestion, finding that low-income persons 
who have little experience with the health care system 
tend to trust doctors more than those who see doctors 
frequently (Crandall, 1981). 

MOTIVATION AND BARRIERS 

Most studies relating to motivation for seeking health 
care focus on barriers — structural, cultural, or psy- 
chological. It seems that while language and other 
cultural barriers can discourage use of the health care 
system, simple logistical problems also play a part. 

Structural. Recent studies confirm earlier findings 
that structural barriers, such as lack of awareness of 
services, cost, and transportation, are significant bar- 
riers to health care. Alcalay's interviews with low- 
income Hispanic women in Albuquerque (1981-82) 
showed that an important barrier was simply not 
knowing where to go. Similar findings among Asian- 
Americans were reported by Ito (1981). Of those 
requiring medical care, he found that 11 percent did 
not see a doctor; most said it was because they did not 
know where to go. Problems of cost, language, and 
transportation were the other reasons. The women in 
Alcalay's study also mentioned cost and, less frequent- 
ly, transportation difficulties as reasons for not seek- 
ing perinatal care. In addition, Steward's study of 
Navajos found that logistical barriers — location of 
health facilities and transportation problems — were 
more important barriers to medical care than folk 
beliefs. 

Even among patients in the health care system, 
structural barriers may occur, as in the public health 
clinic studied by Lazarus (1984). The clients of this 
clinic, white and Puerto Rican women, regularly 
waited 2 to 3 hours to see a doctor, sometimes because 
of registration inefficiencies, lost charts, and missing 
personnel; sometimes, because doctors were called to 
administrative meetings during appointment hours. 
Lazarous found that the "diffuse management" of the 
clinic, with no one person providing leadership, con- 
tributed to these situations. Patient education was 
scheduled after appointments, by which time the 
women were long overdue at home and anxious to 
leave. Seeing a different nurse each time and the lack 
of a private place in which to discuss personal topics, 
such as birth control, further discouraged communica- 
tion between this clinic's providers and patients. 



Cultural. Many studies attest to the importance of 
cultural barriers between health professionals and 
low-income minority clients. These may be nuances of 
language (Washington, 1983), perceptions of health 
needs (Falvo, 1983), or the roles of family or tradition- 
al practices (Zepeda, 1982). The earlier literature 
tended to view family ties and folk beliefs as barriers 
(Andersen, 1981), but more recently researchers have 
suggested that these do not always conflict with mod- 
ern health care and may even serve as vehicles for 
health education (American Hospital Association, 
1982; Snow, 1983; Zepeda, 1982; Steward, 1980). 

The Juarez report noted that Hispanics in the U.S. 
were in a state of transition. However, two major com- 
mercial marketing studies recently addressed the 
issue of Hispanic acculturation, and both found that 
Hispanics were identifying more, rather than less, 
with their native culture. Yankelovich, Skelly and 
White, in a 1984 study sponsored by SIN, the Hispanic 
TV network, found that although regional and cultur- 
al differences among Hispanics in the U.S. were dis- 
appearing, Hispanics' sense of cultural identity was 
increasing. Another commercial marketing study in 
1984 by the Strategy Resource Corporation found that 
U.S. Hispanics were becoming more dependent on the 
Spanish language; in addition, more of those inter- 
viewed for this study now felt that it was important to 
pass on their cultural heritage to their children than 
had felt a few years earlier (Shields, 1984). 

A few studies suggest that socioeconomic barriers may 
be important in themselves, independent of ethnic 
group. Ansari (1982) counted visits to a community 
health center by Whites, Blacks, and Mexican- 
Americans following a community health education 
campaign on preventive medicine. Categorizing the 
visits as either "preventive" or "episodic," he found 
that Anglos made the most preventive visits followed 
by Mexican-Americans and then Blacks. But when 
socioeconomic levels were held constant, there were no 
ethnic differences. Supporting this concept, Tajalli's 
study (1984) of middle-income Hispanics found that 
they used prenatal health services as often as Anglos. 
And Lazarus (1984), in a study of poor White and 
Puerto Rican clients of a public health clinic, found 
that their use of services, their attitudes, and their 
lack of information about pregnancy and birth were 
similar; socioeconomic rather than cultural factors 
appeared to shape their behavior and beliefs. 

Psychological: Several psychological barriers were 
identified from the Juarez focus groups: unfamiliarity 
with long-range planning, the difficulty of changing 
habits, and the existence of other life problems. In 
addition, Ansari's findings (1982) suggest that fami- 
lial disruption discourages Blacks and Hispanics from 
seeking preventive care. 

Positive motivation for healthful practices during 



11 



HEALTH EDUCATION FOR LOW -INCOME GROUPS 



pregnancy may be founded on concerns with physical 
appearance and comfort, according to the Juarez re- 
port, a finding supported by the evaluation of the 
Federal Government's HealthStyle Campaign (Public 
Health Service, 1982). The HealthStyle target audi- 
ence analysis, which oversampled Blacks and Hispan- 
ics, suggested that aesthetic and social concerns are 
important motivators for healthful behavior. How- 
ever, some doubt is thrown on this hypothesis by one 
study of Mexican-Americans (McClintock, 1981), 
which found that lower-SES pregnant women were 
more likely to be motivated by an interest in the baby's 
needs than their own (in contrast to white-collar 
Mexican- Americans and Anglos). 



COMMUNICATION STRATEGIES 

In the past few years, two general health communica- 
tion strategies have received a great deal of attention: 
use of the media and sensitivity to cultural dif- 
ferences. A few researchers have worked closely with 
these approaches and made some recommendations. 
In general, media compaigns appear to be most effec- 
tive when combined with personal counseling, and 
personal counseling seems most effective when ethnic 
practices are incorporated into the teaching. 

Media Strategies. One study has compared three dif- 
ferent communication strategies involving media in a 
clinic's waiting room (Li, 1984). Conducted in a New 
York City family planning clinic, it tested three 
approaches to smoking cessation. One group of women 
was asked to fill out a questionnaire on their smoking 
habits and was then counseled by a physician for 3 to 5 
minutes. Another group was exposed to waiting room 
media — a film and a poster — while the third group 
was exposed to both the media and physician counsel- 
ing. The women in the two groups counseled by a 
physician were more likely to quit smoking than those 
who saw only the film and poster. Those who were 
exposed to both the media and the physician counsel- 
ing had a significantly higher quit-rate than those 
exposed only to the media. The authors conclude that 
personal communication is a valuable supplement to 
educational media. 

Personal communication combined with mass media 
also was found to be important in the Stanford Three- 
Community Study, which compared a bilingual public 
health education campaign on cardiovascular risk fac- 
tors in three California towns (Alcalay, 1983). In the 
first community, only the mass media portion of the 
campaign was used; in the second, mass media was 
supplemented by personal instruction for high-risk 
persons (through community groups); and the third 
community, serving as a control group, was not ex- 
posed to the campaign at all. In the population exposed 
to personal instruction supplemented by mass media, 



the campaign was most successful. Both communities 
exposed to the campaign achieved a reduction in risk 
factors compared with the control population, but the 
reduction was significantly greater in the community 
where personal instruction was used. 

What kind of mass media is most effective? Some stud- 
ies have suggested that television and radio dramas 
may be effective conduits of health information. The 
Juarez focus group participants reported remember- 
ing health information conveyed in soap operas and on 
"FYI," and Ramirez (1983) reported a high rate of 
response to a radio novella. Another innovative 
approach is described by Danaher (1984) who found 
that a smoking cessation program incorporated into a 
local news program had some success, especially 
among those who wrote in for the free booklet offered. 

Public service announcements (PSAs) have had re- 
ports of mixed success. Ramirez (1981) found that 
PSAs on high blood pressure, carefully developed to 
appeal to a specific audience, were successful in 
motivating visits to physicians although they 
appeared to have little effect on knowledge. Likewise, 
the HealthStyle campaign's PSAs, posters, and book- 
lets seemed to have little effect on their urban au- 
diences, according to an evaluation conducted 8 
months later (Public Health Service, 1982); however, 
the campaign did appear to have made the target 
audience more positive in its ratings of local health 
programs, and this improvement was most marked 
among Hispanics and Blacks. A lead poisoning educa- 
tion campaign in Baltimore had somewhat similar 
results (Ross, 1980). The campaign, which consisted 
primarily of personal counseling, did not seem to in- 
crease knowledge significantly, but the target audi- 
ence, urban and 91 percent Black, was more likely to 
use the lead screening services available after the 
campaign. 

Can mass media campaigns reach different segments 
of the population? The answer is yes, according to 
Fortmann, et al (1982), if they are carefully designed. 
Their study of social factors in relation to diet, weight, 
and cholesterol before and after the Stanford Three- 
Community Study found that over the 3 years of the 
campaign, all SES groups reported 20 to 40 percent 
decreases in dietary cholesterol and saturated fat; the 
decreases were at least as large in low-SES and 
Spanish-speaking groups as in high-SES groups. 
Pointing out that the campaign was carefully de- 
signed to reach Spanish speakers and low-SES per- 
sons, these researchers conclude that "preventive pro- 
grams can be designed to appeal to all social groups in 
a community." 

It should be noted that any researcher attempting to 
evaluate the effects of a mass media campaign is beset 
with difficulties. Lau, et al. (1980) analyze the prob- 



12 



HEALTH EDUCATION FOR LOW -INCOME GROUPS 



lems in their review of televised health campaigns of 
the 1960s and 1970s and offer, in conclusion, an out- 
line of an ideal evaluation. 

Cultural Sensitivity. The emphasis in the earlier 
literature on the need for health professionals to 
understand cultural differences has led to at least 
three recent resource books on intercultural health 
communications. One, prepared by the American Hos- 
pital Association in 1982, describes the cultural char- 
acteristics of four groups — Blacks, Hispanics, 
Asian and Pacific-Americans, and American Indians 
— with special reference to cultural sensitivities and 
potential communication problems. The guidelines 
are based on a literature review and on interviews 
with health professionals, cultural centers, and ethnic 
group members. The second, published by Planned 
Parenthood (Andrade, 1982), discusses Latino fami- 
lies' needs and sensitivities. The third (Henderson, 
1981) is a collection of essays on the health attitudes 
and practices of many cultural minorities. These and 
many of the authors cited earlier recommend that 
health professionals seek ways to work with, rather 
than against, cultural attitudes and customs. 

In addition to these resources, a step-by-step plan for 
developing a culturally relevant health education 
campaign is provided by Ramirez (1981). She outlines 
10 planning phases, from definition of the target audi- 
ence through evaluation and modifications, used suc- 
cessfully in a campaign to reach Mexican-Americans 
with information on cardiovascular risk factors. 

A few other reports offer health professionals isolated 
pieces of advice for communicating with low-income 
women. Zepeda (1982), for instance, discusses ways of 
approaching the issue of binding the baby's umbilical 
cord, a practice followed by some Hispanics. Washing- 
ton (1983) notes that the presence of a male health 
professional hindered Hispanic women's participation 
in health education classes. A report on an adolescent 
prenatal care program emphasizes the need for con- 
crete, detailed, and repetitive information (Westman, 
1984). 

A final point, which is made repeatedly in the litera- 
ture, deserves emphasis: there is significant diversity 
within ethnic groups. The AHA resource guide cited 
above differentiates between levels of acculturation 
within each group. The differences among Hispanics 
are emphasized by Alcalay (1981), Ramirez (1981), 
and the Juarez report, among others. Washington 
(1982) notes that Hispanics from one South American 
country may find certain words offensive that are neu- 
tral to those from another country. All make the point 
that clinicians and health educators must be sensitive 
to the differences within ethnic groups, as well as 
between them, in order to communicate effectively. 



SUMMARY 

It is difficult to draw conclusions from studies that are 
not comparable. Target populations and methodolo- 
gies differ widely. The researchers mentioned in this 
review have approached health education from many 
different perspectives using informal surveys, 
scientific samplings, case studies, and in a few cases, 
controlled comparison. However, taken together, the 
findings do suggest some tentative generalizations: 

• The broadcast media and some magazines are im- 
portant sources of information for low-income groups. 
Dramas, documentaries, and other forms of program- 
ming should be considered in addition to PSAs in de- 
signing a health education campaign. 

• Traditional health practices and families may be 
important emotional supports but they are usually not 
barriers to acceptance of medical advice. Many au- 
thors suggest that health professionals be aware of 
and make use of cultural traditions as ways to reach 
their patients. 

• Logistical factors are significant barriers to obtain- 
ing health care for low-income groups. Many people do 
not know where to go or have trouble getting there. 
Some educational campaigns seem to have helped re- 
move this barrier. 

• When personal counseling supplements a mass 
media health education campaign, the campaign may 
have a greater impact. Respect for health 
professionals as sources of health information is high, 
according to some studies. 

• Knowledge of specific cultural attitudes and 
behaviors is important in communicating with 
members of minority groups. Health professionals 
also must realize there are differences within ethnic 
groups, such as between Hispanics from different 
South American countries. Hispanics in the U.S. 
appear to be maintaining a strong cultural identity. 



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Alcalay, R., "Perinatal Care Services for Hispanic Women: A Study 
of Provider-Receiver Communication," International Quarterly of 
Community Health Education, 1981-82, 2(3), pp. 199-214. 

American Hospital Association, Culture-Bound and Sensory Bar- 
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for Health Education, Springfield, VA: National Technical In- 
formation Service, 1982; PB84-193028. 

Andersen, R. et al., "Access to Medical Care Among the Hispanic 
Population of the Southwestern United States," Journal of Health 
and Social Behavior, March 1981, 22, pp. 78-89. 

Andrade, S., ed., Latino Families in the United States: A Resource- 
book for Family Life Education, Philadelphia, PA: Planned Par- 
enthood Federation of America, 1983. 

Burgoon, J., "Mass Media Use, Preferences, and Attitudes Among 
Adults," in Mexican Americans and the Mass Media, Norwood, 
NJ: Ablex, 1983. 



13 



HEALTH EDUCATION FOR LOW-INCOME GROUPS 



Camazine, S.M., "Traditional and Western Health Care Among the 
Zuni Indians of New Mexico," Social Science and Medicine, 1980, 
14B, pp.73-80. 

Chan- Yip, A. and Kramer, M., "Promotion of Breast-Feeding in a 
Chinese Community in Montreal," Canadian Medical Associa- 
tion Journal, November 1, 1983, 129, pp. 955-958. 

Chilton Research Services, Exposure to Print and Electronic Media: 
Women Age 18-34, Radnor, PA: Chilton Research Services, Jan- 
uary 1982. 

Chong, C.L., "Vietnamese in America: A Case Study in Cross Cultu- 
ral Health Education" Health Values, May/June 1984, 8(3), pp. 
16-20. 

Crandall, L. and Duncan, R., "Attitudinal and Situational Factors 
in the Use of Physician Services by Low-Income Persons," Jour- 
nal of Health and Social Behavior, March 1981, 22, pp. 64-77. 

Danaher, B.G. et al., "Mass Media Based Health Behavior Change: 
Televised Smoking Cessation Program," Addictive Behavior, 
1984, 9(3), pp. 245-253. 

Davis, M.F. and Iverson, D.C., "An Overview and Analysis of the 
Health Style Campaign," Health Education Quarterly, Fall 1984, 
11(3), pp. 253-272. 

Falvo, D. and Achalu, D., "Differences in Perception of Health 
Status and Health Needs Between Refugees and Physicians Pro- 
viding Care," Health Values, September-October 1983, 7(5), pp. 
20-24. 

Fortmann, S.P. et al., "Does Dietary Health Education Reach Only 
the Privileged? The Stanford Three-Community Study," Circula- 
tion, July 1982, 66(1), pp. 77-82. 

Greenberg, B. and Heeter, C, "Mass Media Orientations Among 
Hispanic Youth," Hispanic Journal of Behavioral Sciences, Sep- 
tember 1983, 5(3), pp. 305-323. 

Gombeski, W. et al., "Health Information Sources of the Poorly 
Informed: Implications for Health Educators and Com- 
municators," Health Values, 1981, 5, pp. 199-206. 

Hazuda, H.P. et al., "Ethnic Differences in Health Knowledge and 
Behaviors Related to the Prevention and Treatment of Coronary 
Heart Disease: The San Antonio Heart Study," American Journal 
of Epidemiology, June 1983, 117(6), pp. 717-728. 

Ito, K.L. and So, A., "Asian-American Field Survey: Re-Analysis of 
Health Data," paper presented at the Annual Conference of The 
National Association for Interdisciplinary Studies, Las Cruces, 
NM, April 23, 1984, ERIC ED228339. 

Juarez and Associates, Healthy Mothers Market Research: How To 
Reach Black and Mexican-American Women, Final Report, sub- 
mitted to Office of Public Affairs, U.S. Public Health Service, 
contract no. 282-81-0082, 1982. 

Lazarus, E., Pregnancy and Clinical Care: An Ethnographic In- 
vestigation of Perinatal Management for Puerto Rican and Low- 
Income Women in the United States, Ph.D. Dissertation, Case 
Western Reserve University, 1984. 

Levy, S. et al., "Adolescent Pregnancy Programs and Educational 
Intervention: A Research Synthesis and Review," Journal of the 
Royal Society of Health, June 1983, 103(3), pp. 99-103. 

Li, V. et al., "Smoking Cessation With Young Women in Public 
Family Planning Clinics: The Impact of Physician Messages and 
Waiting Room Media," Preventive Medicine, September 1984, 
13(5), pp. 477-489. 

Main, Denise M. et al., "Can Preterm Deliveries Be Prevented," 
American Journal of Obstetrics and Gynecology, April 1, 1985, 
151(7), pp. 892-898. 

McClintock, E., "Prenatal Health Need Perceptions: Mexican- 
American and Anglo-American Comparisons,' paper presented 
at the Annual Meeting of the American Anthropological Associa- 
tion, Los Angeles, CA, December 6, 1981. 

Muecke, M.A., "Caring for Southeast Asian Refugee Patients in the 
USA," American Journal of Public Health, April 1983, pp. 431- 
438. 

Neeson, J. et al., "Pregnancy Outcomes for Adolescents Receiving 
Prenatal Care by Nurse Practitioners in Extended Roles, "Jour- 
nal of Adolescent Health Care, June 1983, 4(2), pp. 94-99. 

O'Guinn, T. and Meyer, T., "Segmenting the Hispanic Market: The 
Use of Spanish Language Radio," Journal of Advertising Re- 
search, December 1983/January 1984, 23(6), pp. 9-16. 



Orstead, C. et al., "Efficacy of Prenatal Nutrition Counseling: 
Weight Gain, Infant Birth Weight, and Cost Effectiveness," Jour- 
nal of the American Dietetic Association, J anuary 1985, 85(1), pp. 
40-45. 

Peoples, M.D., and Siegel, E., "Measuring the Impact of Rahl Pro- 

Erams for Mothers and Fact Infants on Prenatal Care and Mort 
ow Birth Weight: The Value of the Refined Analyses, Associa- 
tion of Medical Care, 21(6), June 1983. 

Ramirez, A. et al., Communication Strategies for Reaching Minor- 
ities, paper presented at 1980 Forum on Hyptertension in Minor- 
ity Populations, May 8, 1980, Washington, D.C. 

Ramirez, A. et al., "El Asesino Silencioso: A Methodology for Alert- 
ing the Spanish-Speaking Community," Urban Health, June 
1981, pp. 44-48. 

Ramirez, A. and Cousins, J., "Hispanic Women's Health Issues: 
Understanding a Mosaic Population," paper presented at the An- 
nual Meeting of the American Public Health Association, Novem- 
ber 13-17, 1983. 

Ross, C.K., An Approach to Increasing Lead Poisoning Follow-Up 
Sreening in an Urban Lower-Income Population, Executive Sum- 
mary, Springfield, VA: National Technical Information Service, 
1980, PB81-211146. 

Ryan, R., Maternal Demographics, Prenatal Care Adequacy and 
Pregnancy Outcomes in Kansas 1980-1982: Basis for Program 
Development in Client Education, Ph.D. Dissertation, Kansas 
State University, 1984. 

Shields, M., "Target Marketing: Hispanics Step Out of the Melting 
Pot: The Debate Continues," Madison Avenue, December 1984, 
26(12), pp. 66-76. 

Smith-Santopietro, M.C., "How to Get Through to a Refugee 
Patient," RN, January 1981, pp. 43-49. 

Snow, L.F., "Traditional Health Beliefs and Practices Among 
Lower-Class Black Americans," The Western Journal of Medi- 
cine, December 1983, 139, pp. 820-825. 

Sokol, R.J. et al., "Risk, Antepartum Care, and Outcome: Impact of a 
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August 1980, 56(2), pp. 150-156. 

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295-300. 

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Care, XVIIIQ2), p. 1183. 

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Champaign, 1984. 

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16-18. 

Wiles, L., "The Effect of Prenatal Breastfeeding Education on 
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JOGN Nursing, July/ August 1984, 13(4), pp. 253-257. 

Zacharias, J., "Childbirth Education Classes: Effects on Attitudes 
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Zepeda, M., "Selected Maternal-Infant Care Practices of Spanish- 
Speaking Women," JOGN Nursing, November/December 1982, 
11(6), pp. 371-374. 



14 



PREPREGNANCY PROGRAMS 



3 



Prepregnancy 
Programs 



Prepregnancy programs confront a unique challenge: 
attracting clients before any medical need is apparent. 
"Guidance," "referral," and "information" were the 
goals identified most frequently by the 51 programs 
responding to the survey; and outreach, counseling, 
and education were the means used to reach their 
objectives. 

The returned survey forms revealed many similarities 
among prepregnancy programs. Funding is most often 
provided by State and local governments; but many 
clinics cited client contributions based on a sliding 
scale as another source of funds. (A problem commonly 
mentioned was government budget cutbacks, com- 
bined with increased client loads.) Teenagers are tar- 
geted by many programs, although few restrict ser- 
vices to one age group. These programs serve a wide 
variety of ethnic groups. 

Only two responses were received from genetics 
screening and counseling services, perhaps because 
distribution of the survey was targeted to programs 
serving low-income women, and most genetics ser- 
vices are directed to all women. 



SERVICES AND STRATEGIES 

Most prepregnancy programs responding to the sur- 
vey are clinic-based and offer both medical services 
and counseling. A typical clinic offers family planning 
advice, pregnancy testing, PAP smears, and testing 
and treatment for sexually transmitted diseases. Re- 
ferral to other health care resources was also men- 
tioned as a standard service. As Planned Parenthood 
of Mohawk Valley in Rome, New York, wrote: 

• Large numbers of pregnancy tests are done 
where limited prenatal care is available; there- 
fore, we have the opportunity and obligation to 
try to ensure that clients will seek prenatal care. 

Counseling and education. Counseling and educa- 
tion were reported as integral parts of the clinics' 
services. Counseling can occur in a variety of 
settings — one-on-one meetings, small group classes, 
clinic waiting rooms. 



Risk assessments. Survey responses described sever- 
al patient education programs based on risk assess- 
ment that were developed especially for family plan- 
ning clinics. 

• The East Midlands Health District, South 
Carolina Department of Health and Environ- 
ment, uses a short quiz, HealthStyle, from the 
U.S. Public Health Service to identify patients' 
risks. Clients in the health department's family 
planning clinic take the quiz in the waiting 
room and then are given a packet of education- 
al materials on one of three topics — high blood 
pressure, weight control, or smoking — 
depending on the results. The packets are in- 
tended to be read in the waiting room and left 
there. 

• Another self-administered health appraisal 
is the basis of the University of North Caro- 
lina's Preconceptional Health Promotion Pro- 
gram. Used in local health departments' family 
planning clinics, the appraisal identifies 
potential problem areas. A series of follow-up 
pamphlets in simple English, developed by the 
program, recommends ways to prevent poten- 
tial problems. 

• A thirdproject, the Preconceptional Interven- 
tion Project in Orangeburg, South Carolina, 
seeks to identify and eliminate risk factors in 
pregnancy through clinical screening. Clinic 
staff identify the risk factors — such as obesity, 
diabetes, alcohol use, and genetic disorders — 
and patients participate in educational and be- 
havior change programs tailored to their 
needs. 

Male involvement. One survey respondent described 
a Male Involvement Program offered by Planned Par- 
enthood in Grand Rapids, Michigan. The Program "is 
designed to encourage men to come with their part- 
ners to the clinic. It is also designed to provide educa- 
tional information and materials for men." Con- 
traceptive supplies, private counseling, and an in- 
formation packet for men are available. Men and their 



15 



PREPREGNANCY PROGRAMS 



partners may participate in family planning con- 
sultations, pregnancy test visits, and teen rap ses- 
sions. A male educator is available for counseling. 



STAFFING 

Whatever the form — informal or formal — or setting — 
one-on-one, small group, classroom, or on the 
telephone — quality staff training was repeatedly cited 
as critical and essential to success. 



GUIDELINES FOR COUNSELING 

The responsibility of any educator is to present 
sound, concise information on the learner's level of 
understanding. 

Absorption and integration of the information will 
presumably enable the learner to make wanted 
changes in his/her life. 

Almost all the responsibility for acting on the in- 
formation lies with the learner. For example, giv- 
ing a person directions in the street enables him/her 
to get from point A to B; something he/she pre- 
viously didn't know. The responsibility of following 
the directions is up to him/her. 

Counseling adds a function to education. 

Besides imparting information, it is the responsi- 
bility of a counselor to help the learner integrate the 
information into his/her experience, to help in the 
decision-making process (change). 

Education can be impersonal; counseling is always 
personal. 

Education does not require feedback and two-way 
communication; counseling does not exist without 
it. 

Education involves imparting factual knowledge 
on: 

a. how pregnancy occurs 

b. effects of unregulated fertility, physically and 
emotionally 

c. the menstrual cycle 

d. methods of birth control 

e. correcting misinformation patient may have 

f. instructing in use of chosen method 

Counseling involves: 

a. exploration of patient's interest in controlling 
fertility 

b. exploration of patient's life style 

c. exploration of patient's physical condition 

d. discussion of pros and cons of methods in light 
of"a,""b,"and"c" 

(From the In-Hospital Program, New York City) 



• At the Long Beach Family Planning pro- 
gram in Long Beach, California, telephone 
counseling and follow-up are considered so im- 
portant that the staff, including clerical help, 
are given twice monthly classes on telephone 
counseling. 

Involvement of staff in planning programs and choos- 
ing materials is also important. For example, the Pre- 
conceptional Promotional Program in Chapel Hill, 
North Carolina offered this guidance to others: 

• Start with a small effort and involve the peo- 
ple who will be implementing the program in 
the design phase; 

• Continually demonstrate a high level of 
sensitivity to the constraints faced by clinic 
staff, in terms of time, space, and personnel; 

• Allocate significant time to staff education 
and provide ample reference resources; 

• Test tools (i.e., pamphlets, health risk ap- 
praisal) on patients and staff for acceptability 
and usefulness before using. 

In addition to professional staff, many programs rely 
on peers, parents, and volunteers as resources to reach 
their target groups. Some examples are cited in the 
"Outreach" section of this chapter, along with sugges- 
tions for training unpaid staff. 



OUTREACH 

Outreach is an important tool for survey respondents 
who have developed extensive services outside their 
clinics. In addition to schools, respondents stressed the 
need to reach the high-risk population in other com- 
munity settings such as churches and Head Start pro- 
grams. Several groups mentioned that "word-of- 
mouth" had the most impact on their target popula- 
tion. Some examples of active outreach programs 
follow. 

• In Wauwatosa, Wisconsin, the March of 
Dimes Birth Defects Foundation has initiated 
a health education program for prison inmates 
which includes reproductive health and family 
planning. Prison staff decided on dates and 
times and were consulted on the needs of the 
prisoners as the program was designed. The 
classes include anatomy, basic concepts of love 
and caring, family planning methods, sexually 
transmitted diseases, and smoking. The pro- 
gram also gives information on health facilities 
in the area for sexually transmitted disease 
testing and treatment and for sickle cell and 
Tay -Sachs screening. 

Outreach efforts relying on paraprofessionals and 
volunteers are also successful in meeting client needs. 



16 



PREPREGNANCY PROGRAMS 



For example: 

• Described as an "in-reach" rather than an 
out-reach program, the In-Hospital Program 
in New York City brings family planning in- 
formation to the bedside of women who have 
just given birth. Community -based, parapro- 
fessional counselors explain the family plan- 
ning methods available, help each woman 
choose the method best for her, and ensure that 
she receives her method of choice before hospi- 
tal discharge. The program reaches women at a 
time when there are fewer distractions than 
may be usually present and at a time of high 
motivation for family planning information. 

• The Askable Parents Program in New York 
City works with community agencies to help 
parents become more comfortable as the key sex 
educators of their children. "To accomplish 
this goal," reads the program description, "the 
program relies on the existing support net- 
works parents use: church, school, community 
organizations. As facilitators, we chose to use 
peers who would serve as role models and, as 
parents themselves, understand the concerns 
and problems parents face in this most perplex- 
ing and difficult task. Parent-leaders receive 
specialized training in sex education, commu- 
nications, and group leadership skills. Most 
parent-leaders are active in community organ- 
izations and were chosen by these organiza- 
tions to receive training. Parent-leaders receive 
a small stipend to defray out-of-pocket ex- 
penses; however, their commitment is basically 
that of a volunteer." The Program has targeted 
the areas of the city with the highest rates of 
adolescent pregnancy . In the 5 years of its exist- 
ence, it has reached from 360 to 1 ,800 parents a 
year and received favorable evaluations from 
participants and parent -leaders. 

• Planned Parenthood in Youngstown, Ohio, 
sponsors a Panel of Parents, which presents 
school programs on teen parenthood. As single, 
teen mothers, the panelists talk about their own 
experiences and answer questions from their 
audience. The panelists are screened carefully 
for communication skills and the target audi- 
ence has reacted positively to the program. 
"Students complete evaluation forms and their 
comments tear at the heartstrings," noted this 
survey respondent. "They truly appreciate 
hearing the facts from their peers." 

EDUCATIONAL PROGRAMS 

Comprehensive prepregnancy educational programs 
are often multifaceted. For example, the Women's 
Health Programs at the Indian Boarding School in 



HOW TO PUT 
A PARENT PANEL TOGETHER 

Early in September, a mailing list is sent to school 
counselors and social service workers, asking them 
to distribute "recruitment cards" to teen parents 
they feel would be interested in participating in and 
effective as members of a panel. Prospective pan- 
elists return the cards to the Coordinator, if they are 
interested, and they are called for an interview. At 
least eight to ten candidates are interviewed, and 
the most suitable are selected. 

Training 

One session is held before the first speaking 
engagement at which we — 

• build the team 

• give information on community agencies dealing 
with teen problems 

• give information on Planned Parenthood 

• practice a 5-minute presentation and public 
speaking techniques 

Engagement Logistics 

Panel members are responsible for their own trans- 
portation and babysitting arrangements. A sched- 
ule of engagement times, places, and directions is 
sent to panel members in advance. (Babysitting is 
reimbursed.) 

Evaluation 

A form is passed to classes at the end of the presen- 
tation, asking overall rating of the program, com- 
ments on each part (situation/story/discussion, sta- 
tistics) and any change in attitude brought about by 
hearing the panel. (From Planned Parenthood of 
Mahoning Valley, Youngstown, Ohio) 

Riverside, California, instituted an active family 
planning program with five major components: a ma- 
jor publicity campaign, guaranteed confidentiality, 
easily accessible services, an active outreach and re- 
ferral system, and a nonjudgmental, understanding 
attitude on the part of clinic staff. A marked decrease 
in pregnancies and increase in contraceptive use has 
been the result of this program, whose staff com- 
mented, "We have a captive audience, but we still 
have to encourage use of services." 

Materials. Educational materials are an important 
tool in family planning and prepregnancy programs. 
Many survey respondents use Planned Parenthood 
and March of Dimes, and State health department 
materials. One respondent recommended requesting 
assistance from the Planned Parenthood Federation 
prior to beginning a program. 



17 



PREPREGNANCY PROGRAMS 



Because educational materials can be expensive, the 
East Midlands Health District, South Carolina De- 
partment of Health and Environmental Control has 
developed a simple evaluation process to pretest mate- 
rials before purchase. Using this process, East Mid- 
lands selected materials for patient education packets 
on three topics. (See description of this program under 
Risk Assessments.) This program stressed the need for 
inservice training to encourage staff reinforcement of 
information presented in the materials. 

Other programs have developed their own materials: 

• The Teen Reach Program in New York City 
has developed a curriculum specifically for 
inner-city schools. Based on a DHHS curric- 
ulum, "A Decision-Making Approach to Sex 
Education," materials have been adapted for 
an audience with a wide variation in reading 
and writing skills. This program has also de- 
veloped new sections to emphasize topics felt to 
be especially important to inner -city adoles- 
cents. 

• Planned Parenthood in Kalamazoo, Michi- 
gan, developed a cable program, "Every Child 
a Wanted Child," which won a first place 
national 1984 Award for Cable Excellence. 
Networking played an important role in this 
project, with Western Michigan University act- 
ing as television production agent, a local grant 
supporting initial planning and production, 
and the Kalamazoo Community Access Center 
providing the first cablecasting of the six, half- 
hour programs. The six segments are now 
available for use by other organizations. 



NEEDS FOR EDUCATIONAL MATERIALS 

The need for materials was most often cited by survey 
respondents, with quite specific topics and formats 
requested. Included were: materials prepared for 
clients with reading difficulties; a brochure on sexual- 
ly transmitted diseases written at a 4th grade reading 
level; simple pamphlets on the potential effects of high 
blood pressure, smoking, and obesity on future pre- 
gnancy; Creole-language materials; father-to-son 
literature stressing the "manliness" of using a con- 
dom; materials to help teens acquire and build self- 
esteem and communicate effectively with their fami- 
lies; and literature on the health risk of pregnancy 
before age 17 and at less than 1-year intervals. 



dents offered numerous practical suggestions. Some of 
these are listed below: 

• Have Sunday morning and some evening 
hours to make services available to women who 
cannot come at other times. (University Family 
Planning Program, Miami, Florida) 

• Give tours of clinics for school-based pro- 
grams. (Teen Reach Programs, New York 
City) 

• Include coupons for free pregnancy tests with 
food stamp mailings. Note: Those receiving the 
coupons were eligible for free testing anyway, 
but the coupon increased participation rates. 
(Auglaize County Health Department, Wado- 
koneta, Ohio) 

• Advertise in restaurants and laundromats 
near the trailer parks. (Auglaize County 
Health Department, Wadokoneta, Ohio) 

• Locate in an accessible spot and operate at 
convenient times. (Planned Parenthood of 
Mahoning Valley, Youngstown, Ohio) 



FILM MAKING TIPS 

Recommendations for video production from the 
producers of "Every Child a Wanted Child": 

• Use individuals from assorted and racial/ethnic 
backgrounds in filming. 

• Script carefully, using real situations and real 
people. 

• Use graphics that teach, in addition to situational 
training and lecture/discussion, for reinforcement. 

• Market widely to reach as many people as possi- 
ble. 

(From Planned Parenthood, Kalamazoo, Michigan) 



ADVICE AND OBSERVATIONS 

Beyond the often-expressed need for sensitivity to the 
emotional and cultural needs of clients and the neces- 
sity for careful planning and patience, survey respon- 



DDD 



18 



PRENATAL SERVICES 



4 



Prenatal 
Services 



A broad spectrum of prenatal programs are repre- 
sented in the 223 responses in this category. Some 
emphasize clinical care; some focus on classes or offer 
other kinds of instruction and support; and some spon- 
sor public information campaigns. Within each group 
are programs that describe special strategies for 
reaching low-income women and retaining them in 
the health care system. 

Many prenatal programs are marketing services, 
engaging in outreach, and developing strategies to 
attract low-income women; and many wrote of the 
results with enthusiasm. As a Coalition reviewer com- 
mented, they are seeing, through formal and informal 
evaluations, that their work makes a difference, and 
this has encouraged them to continue and expand 
their efforts. 



SERVICES AND STRATEGIES 

With funds from State and local governments, sup- 
plemented in some cases with Federal monies, founda- 
tion grants, and client contributions (on a sliding fee 
scale), clinics provide direct prenatal health care, 
sometimes combined with counseling and classes. 

High-risk screening. Many survey respondents 
work to identify and provide special care to women at 
high risk for delivering a low birth weight baby. For 
example: 

• The Low-Birthweight Prevention Program 
for South Carolina, based in Charleston, has 
Low-Birthweight Prevention Clinics located in 
five health centers around the State. Sponsored 
by the March of Dimes and the State, each 
clinic follows the same protocol. "The strategy 
tested in this program is one using a nurse- 
midwife to give intensive prenatal care to 
patients who early in pregnancy are identified 
as being at risk for delivering a low- 
birthweight infant. These women are identi- 
fied by use of an objective scoring system in 
WIC and health department prenatal clinics 
throughout the State. Women randomized into 



the program are referred to a Low-Birthweight 
Prevention Clinic where they are followed with 
more frequent prenatal visits. In this project 
emphasis is on: 1) prevention or early recogni- 
tion of preterm labor; 2) good nutrition; 3) 
avoidance of adverse health practices such as 
smoking, alcohol, or drug use; and 4) social 
support and stress reduction. The program and 
control groups will be compared at the five cen- 
ters to determine the effect on the incidence of 
low birth-weight and the effectiveness of the 
screening tool for identifying women at risk for 
this problem." 

• The Prematurity Prevention Program in Col- 
orado Springs, Colorado, identifies women at 
risk for premature labor through a simple card 
covering both medical and socioeconomic fac- 
tors, which is filled out by the patient. Those at 
risk are enrolled in a special educational and 
support program offering weekly classes. The 
classes are free, and family members are in- 
vited to attend. A special session is available for 
teenagers. 

• A nother approach was described by the IPOP 
Program in Vero Beach, Florida, which uses 
the Creasy* formula to identify high-risk 
patients. These patients are visited at home by 
public health nurses. 

But it is not only the logistics of low-cost prenatal care 
on which these programs focus. "To encourage and 
allow early entry into prenatal care for the low-income 
target population and to intensify the prenatal care for 
those at risk for low birthweight," is the goal state- 
ment of the Prenatal Care and Nutrition Program in 
Syracuse, New York. Earlier care for more women and 
special attention to high risk pregnancies were goals 
shared by many respondents. 



•Developed by Dr. Robert Creasy at the University of California, San Francisco Medical 
School, the Preterm Birth Prevention Program is a program to reduce the incidence of 
babies born prematurely. The program includes scoring and assigning patients according 
to their risk of having spontaneous preterm labor. Patients in the program are instructed 
in self-detection of labor and those at high risk are followed weekly in a special clinic. A 
major component of the Program is in-service education of the obstetric staff about how to 
work with patients at risk for preterm birth. 



19 



PRENATAL SERVICES 



Coordination with nursing and social services. In 

analyzing obstacles to prenatal care, the Syracuse pro- 
gram cited above found: 

• That entry to prenatal care was too complex 
and imposing, that Medicaid application was 
too complicated, and that prenatal care had 
been too restricted to medical -obstetrical dis- 
orders. It addressed these problems by working 
with the city's departments of health and social 
services. Social workers and public health 
nurses from these departments help patients 
through the complexities of entry to prenatal 
care and a nurse practitioner provides educa- 
tion. With this approach, the clinic found that 
the number of indigent patients registering in 
the first trimester of pregnancy rose from 25 
percent to 46 percent. 

Discounts on delivery for clinic attendance. The 

PRREP program in Cornelius, Oregon, allows 
patients to earn discount coupons, good toward the 
costs of delivery, by actively participating in a pre- 
natal care plan. The coupons are earned at each pre- 
natal visit and can lower delivery charges to $300. 
Funded completely through private foundations, the 
program guarantees a minimum of $100 to each par- 
ticipating obstetrician and $200 to each participating 
hospital per delivery. For this guaranteed amount, the 
hospital and physician agree not to bill patients fur- 

Now you can afford 

the Special Care 

you both deserve 




Ahora es posible 

recibir atencion 

medica durante su embarazo. 



Virginia Garcia Memorial Health Center 



ther. One advantage of this system, said this respon- 
dent, is that: 

• By offering women opportunities of 'earning' a lower 
cost delivery, it eliminates the free care aspect, in- 
corporates the work ethic, and, as a result, puts pride 
and dignity back into the process. 

Coalitions. By joining with other groups in their com- 
munities, some clinics have been able to reach a wider 
range of prospective clients. 

• The Monte fiore Family Health Center's Low - 
Birthweight Prevention Project in the Bronx, 
New York, has become involved in the Bronx 
Perinatal Consortium. "The efforts involve 
public service announcements, press releases, 
and letters to interested politicians in the hopes 
of helping the near poor — those women who 
don't qualify for public assistance, but who are 
unable to afford the cost of prenatal care." 

• A committee of community representatives 
was instrumental in establishing the Prenatal/ 
Postpartum Care Program in Charlotte, 
Michigan. The clinic now uses informal 
arrangements with other community groups to 
increase its patient load. For instance, clinic 
staff provides educational seminars at the 
county's Alternative Education Program 
which, in turn, is a continuing source of refer- 
rals for the prenatal clinic. 

• The East Bay Perinatal Council in Berkeley, 
California is a coordinating body for the ex- 
change of information among hospital ad- 
ministrators, private physicians, county and 
community clinic staff, nutritionists, health 
educators, and support service providers. With 
funds from the State, foundations, and cor- 
porations, the Council "provides basic 
coordination and follow-up staff work, allow- 
ing members to meet monthly to exchange in- 
formation and address emerging perinatal 
issues; gathers and makes available informa- 
tion on perinatal data, trends, and programs; 
acts as a technical resource on perinatal issues 
to providers, policy makers, the press, the pub- 
lic, and students. These activities are the foun- 
dation upon which all other Council work 
rests." Other Council work includes door-to- 
door outreach as well as the "Tell-A-Friend" 
campaign described elsewhere in this chapter. 

Providing continuity. A number of clinics empha- 
sized the importance of continuity in retaining clients. 
"Having one (bilingual) person who the patient knows 
follow through (the prenatal period), during 
hospitalization, and postpartum has made our pro- 
gram successful," wrote the South Cove Community 
Health Center in Boston, which serves new immi- 
grants from China, Vietnam, and Cambodia. 



20 



PRENATAL SERVICES 



Targeting single mothers. The Optimal Pregnancy 
Outcome Project was devised by a community health 
center in Fayo, North Dakota: 

• "To increase the capability and accessibility 
of prenatal and postpartum services to single 
pregnant women and ensure that quality, com- 
prehensive health, social and nutrition services 
are provided...." A project coordinator, nurse 
practitioner, social worker, and nutritionist 
provide pregnancy tests, counseling, and refer- 
rals at four monthly clinics intended to supple- 
ment regular prenatal care. Clinics are well 
attended with only a small percentage of 
missed appointments; in its first 2 years of op- 
eration, the program saw an 18 percent in- 
crease in single women seeking care in the first 
trimester. 

STAFFING 

A mixture of professional, paraprofessional, and 
volunteer staffing is characteristic of prenatal pro- 
grams. These components are discussed below. 

Physicians. Finding the physicians to serve clients is 
a problem for some programs. The Prenatal Clinic for 
Low-Income Women in Hammond, Indiana, for in- 
stance, provides preliminary care, while a social work- 
er attempts to find a physician willing to make a fee 
agreement. But this respondent wrote, "Our funds are 
running out... the physicians who have been taking 
our patients are becoming more and more reluctant to 
do so...." 

Nurse-midwives and nurse-practitioners. Nurse- 
midwives and nurse-practitioners were mentioned 
frequently by survey respondents as primary care- 
givers. The IPOP Clinic, Vero Beach, Florida, is 
staffed by two nurse-practitioners who see patients 
during routine visits and answer calls between check- 
ups. Obstetricians serve IPOP Clinic patients on a 
rotating basis. At the Weber-Morgan District Health 
Department Prenatal Program, Ogden, Utah, clinics 
are staffed by certified nurse-midwives with assis- 
tance from public health nurses and health aides. 
Patients may be delivered by a nurse-midwife or by a 
medical resident at a nearby hospital. 

Nurse-midwives not only deliver babies, but also pro- 
vide prenatal and postpartum care and often educa- 
tion, according to the nurse-midwifery programs 
responding to the survey. Almost all were affiliated 
with hospitals or clinics. 

The time to give personal attention was emphasized as 
a special characteristic of the nurse-midwife by re- 
spondents. "As midwives we provide much one-to-one 
time discussing nutrition, emotional needs, and treat- 
ing our client families as individuals," wrote the Bam- 
berg Nurse-Midwifery Service in Bamberg, South 



Carolina. Nearly all cited statistics demonstrating 
low rates of complications and high rates of normal 
weight, healthy babies. 

The following description typifies a high-quality 
nurse-midwifery program: 

• The Nurse-Midwifery Department of 
Phoenix Memorial Hospital in Arizona "pro- 
vides care, utilizing medical consultation and 
collaborative management, for mothers and 
newborns throughout the maternity cycle.... A 
wide range of educational programs are an 
integral component of the service. A Certified 
Nurse-Midwife is an individual educated in 
the two disciplines of nursing and midwifery, 
who possesses evidence of certification accord- 
ing to the requirements of the American Col- 
lege of Nurse -Midwives.... The Chairman of the 
Department ofOBIGYN, a Board certified ob- 
stetrician, provides medical direction for the 
Nurse-Midwifery Service. The designation of 
patients appropriate for nurse-midwifery man- 
agement is the joint responsibility of the ob- 
stetrician and nurse-midwife." This program 
offers parents various birth options such as low 
lights during the birth and variable positions 
during labor. 

Labor coach volunteers. Asian Health Services, 
Oakland, California, has developed a Labor Coach 
Volunteer program. Its fact sheet for patients ex- 
plains: 

• A labor coach is someone trained to support, 
encourage, and provide comfort to you during 
your labor and delivery.... She can also provide 
translation and act as a liaison between you 
and hospital staff....! f you decide to have a 
labor coach, you can meet her at one of your 
prenatal visits. She will call you periodically to 
see how you are doing. At the time of labor, she 
will then meet you at Highland Hospital and 
stay with you through the delivery. 

Volunteer labor coaches for mothers without com- 
panions are also provided by the Jefferson Davis 
Childbirth Education Association in Houston, Texas, 
which has developed extensive training procedures 
and guidelines for volunteers. "Don't hesitate to let go 
of volunteers who aren't committed or good at what 
you are doing," advises the staff of this program. 

Counselors. The Colorado Low Birthweight Preven- 
tion Project in Denver sends counselors to four local 
public health prenatal clinics. Funded by the Federal 
Government, the Project is developing strategies for 
reducing the incidence of low birthweight. The counse- 
lors: 

• assist women who smoke, use alcohol, are 
gaining weight inadequately, or are severely 
anemic during pregnancy.... This project is 



21 



PRENATAL SERVICES 



based on the premise that many of the births in 
Colorado's "problem" birthweight category 
may be due to behavioral factors alone. This 
hypothesis is supported by the fact that most 
births in this "problem" weight category are not 
premature and are more likely to be in- 
trauterine growth retarded, a condition often 
linked with smoking, alcohol use, and poor 
nutrition. 

Results from an interim evaluation of this program 
show that 41.1 percent of those counseled had reduced 
their levels of smoking, 88.9 percent had stopped 
drinking alcoholic beverages, and 68.8 percent had 
reduced risks stemming from prenatal underweight. 

Other respondents mentioned counseling services to 
help clients apply for WIC assistance, arrange for de- 
livery, and cope with other practical problems. 

Bilingual staff. As part of meeting its goal "to provide 
quality prenatal care with an emphasis on prevention 
and the development of an innovative culturally sensi- 
tive approach in the Asian Community," Asian Health 
Services, mentioned above, has a bilingual staff. "We 
have services in four languages — Chinese, Korean, 
Vietnamese, and English. Most of our patients are 
non-English speaking." This clinic has also produced 
20 educational pamphlets on prenatal care translated 
into Chinese, Korean, and Vietnamese. 



LESSON PLAN-FIRST WEEK 

Here is the lesson plan for the first week of prenatal 
classes at the Perinatal Clinic of Midland, Texas: 

Week 1 - What Should I Expect Now That I'm 
Pregnant? 

• Pamphlet: "So You're Going to Have a 

Baby" 

• Meal Planning: Use Flannel Board (a pro- 

gram audiovisual aid) 

Example: Divide into groups. Pass 
out cardboard food and have a cont- 
est to see which group plans a meal 
first with all necessary parts. Give 
a prize to each member of winning 
group. Must go over necessary parts 
of good diet first and have a chart 
where they can see it. 

• Handout: "Be a Super Snacker" 

• Lamaze Breathing Introduction — Neuro- 

muscular Control 

• Film: "Inside My Mom" (produced by the 

March of Dimes) 

• Snacks 



OUTREACH 

How can prenatal classes and clinics attract low- 
income clients? Sliding fee scales and free services are 
standard for most prenatal programs responding to 
the survey, but they are only a beginning. "A program 
needs marketing prior to startup," wrote the Prenatal, 
Postpartum Care program in Stanton, Michigan, sum- 
ming up the advice of many other respondents. Low 
cost is essential, they said, but there are psychosocial 
and logistical barriers for low-income women that 
must be overcome through promotion and outreach. 

Making services accessible. Two programs reported 
efforts to make clinic services more accessible. 

• A mobile clinic that travels to low-income 
neighborhoods was described by the Richmond 
City Health Department in Richmond, Vir- 
ginia. "The service provides free pregnancy 
testing, 'walk-in' atmosphere, initial inter- 
views, nursing assessment, and referral to ser- 
vices at permanent sites. It offers a means of 
providing many aspects of prenatal care even 
when there is a backlog of clinic appointments, 
or the patient has personal difficulty using a 
permanent site (anxiety, transportation). A 
major advantage of the mobile intake service is 
the ability to change location based on our 
'mapping' of needs. ...The most challenging 
task has been promoting enthusiasm of nurs- 
ing and clerical staff about working in the mo- 
bile clinics.... Advice to others beginning such a 
program would be inclusion of all the staff who 
would be located in such a mobile trailer in the 
planning as well as evaluation proccesses." 

• Satellite clinics in target neighborhoods have 
been set up by the Prenatal Care and Nutrition 
Program in Syracuse, New York. 

Promotion of clinics. Several programs advertise 
their services in ways designed specifically for their 
target audience: 

• The EOC Family Planning /Pre natal Clinic 
in El Centro, California, wrote: "One way 
which has worked in reaching many people 
who otherwise do not normally hear of services 
is through local fairs. We have developed edu- 
cational displays and have had booths at a 
10-day County Midwinter Fair, Red Cross 
Health Fairs, Children's Fairs, and local com- 
munity fairs. After each fair, we see a sub- 
stantial increase in initial patients." 

Wallet cards are another means this program 
uses to promote its services. "We also received 
funding from the March of Dimes to develop 
pamphlets and cards for teens. These were dis- 
tributed at six health fairs held at the local high 
schools. We invited representatives from each 



22 



PRENATAL SERVICES 



of the agencies listed to be at the fairs and 
present information. These were a success and 
5,000 pamphlets and cards (to keep in wallet) 
were distributed. Each agency involved re- 
ported a large increase in teens calling their 
agencies within the first month following each 
fair." 

One-to-one support. Several variations of this 
strategy were described. 

• The Pregnancy Outreach Program of the 
March of Dimes trains volunteers to provide 
emotional support for "at-risk" pregnant 
patients on a one-to-one basis. "Volunteers are 
committed to the patient for a 9-month period 
commencing about the third month of preg- 
nancy, lasting through 3 months after de- 
livery.... The main objectives are to provide 
emotional support and help patients find 
necessary community resources." 

• The Healthy Baby Boston Cooperative Pro- 
gram to Prevent Prematurity, in Massachu- 
setts, uses community health nurses and 
neighborhood health advocates to visit women 
with high-risk pregnancies "for teaching, 
advocacy, or a helping hand with obtaining 
social resources as needed." This program in- 
volves a number of community health centers 
and hospitals in Boston. At each prenatal care 
site, women with a greater possibility for a low 
birthweight infant or premature birth are iden- 
tified by the use of a screening and referral 
form. It is anticipated that about 35 percent of 
women seeking care will be referred to the com- 
munity health team. ...The community health 
staff works in close collaboration with the pre- 
natal care site. ...They will also reach out and 
help women not yet registered for care or hav- 
ing problems obtaining services." 

Following up broken appointments. Keeping 
patients in the health care system is a major concern of 
prenatal programs; there are many strategies for do- 
ing so — reminder cards, letters, phone calls, and 
home visits. One approach is described below: 

• The Maternity -Infant Care, Family Plan- 
ning Project in New York City has clerical staff 
send a routine form letter if one appointment is 
missed and a second "delinquent" letter if the 
next appointment (given in the first letter) is 
missed. A nurse receives the patient's record if 
telephone follow-up is indicated or if a health 
problem exists. If the patient misses the third 
appointment, a nurse determines further 
follow-up which may include: 

- telephone call to patient or "appropriate 
other"; 



- letter to patient or "appropriate other"; 

- consultation with medical and other MIC -FP 
providers; 

- contact with backup hospital or other health 
care/ public service facility; 

- utilization of the New York City Health De- 
partment Outreach Workers; 

- home visit, if feasible and prudent; 

- termination of the patient's record when all 
reasonable attempts at contact have failed. 

EDUCATIONAL PROGRAMS 

The majority of prenatal programs responding to the 
survey provide instruction of some type. Educational 
settings include classes in prepared childbirth, classes 
on general prenatal health, individual counseling, 
group lectures, demonstrations, and discussions. The 
program staff attempt to encourage good health 
habits, reduce anxiety, and prepare women for the 
experience of pregnancy and childbirth. Anecdotal 
evaluations from respondents suggest that this trans- 
lates into fewer low-birthweight babies; they also re- 
ported that one-to-one counseling is most effective. 
Some, like the Parents Classes Program at the Colum- 
bia Hospital for Women in Washington, D.C., offer a 
variety of classes including a Ceasarean birth prep- 
aration course and a 1-hour class for siblings. Smaller 
programs often reported a series of six or seven weekly 
classes covering pregnancy, delivery, and parenting. 

Other classes have been established independently of 
clinics or hospitals. In Tampa, Florida, for instance, 
five community organizations formed a coalition to 
start a program called Prenatal Education for Low- 
Income Women. The school system, a hospital, the 
county health department, the local chapter of the 
March of Dimes, and the Coalition of Florida Child- 
birth Educators combined efforts, each having access 
to different resources and areas of expertise. They 
wrote a successful proposal to obtain State funds, don- 
ated materials and staff, and now provide ongoing 
coordination for evening classes at local high schools. 

Some programs that charge a fee for classes offer full 
or partial "scholarships" for those unable to pay. 
Northern Michigan Health Services, in Houghton 
Lake, Michigan, reported that, through this system, 
"our class numbers are greatly increasing. Physicians 
in area hospitals are very pleased." 

Educational materials. Prenatal education pro- 
grams use a variety of printed materials and au- 
diovisual aids. Many sources were mentioned includ- 
ing companies such as Johnson and Johnson, Gerber, 
Ross Laboratories, Mead Johnson, Prudential In- 
surance, and Metropolitan Life; voluntary associa- 
tions such as the American Red Cross and the March of 



23 



PRENATAL SERVICES 



Dimes; and trade and nonprofit associations such as 
the Maternity Center Association, Health Education 
Associates, the National Dairy Council, and the Soap 
and Detergent Association. 

Some programs have developed materials. The Col- 
orado Low Birth Weight Prevention Project in Denver, 
for instance, has prepared "Having a Healthy Baby," a 
basic pamphlet with inserts on nutrition, smoking, 
alcohol, and stress. Art and layout work was prepared 
by a local hospital's art department, and Mead John- 
son underwrote printing costs. The Guernsey County 
Health Department in Cambridge, Ohio, has de- 
veloped a glossary on pregnancy, as well as materials 
on labor and delivery. Handouts in English and Span- 
ish on exercise and infant feeding have been prepared 
by Preparation for Childbirth at the Claretian Medi- 
cal Center in Chicago. 

A slide tape, designed to help pregnant women recog- 
nize the six warning signs of preterm labor, has been 
produced by Preterm Birth Prevention in Raleigh, 
North Carolina. A follow-up quiz and a wallet card 
listing the warning signs reinforce the slide-tape mes- 
sage. 

Encouraging attendance. Simply making classes 
and educational materials available, said some survey 
respondents, is not enough because these women have 
psychosocial and other needs that take priority over 
education. "The chief problem involved with this pro- 
gram is getting the clients to attend the classes," wrote 
the Prenatal Clinic in Colorado Springs, Colorado. 
This problem was echoed by a nurse responding from 
the Patient Education Program in a clinic in Redwood 
City, California: 

• It's an uphill battle as the women who need 
help most are apathetic — they don't see the 
need.... Don't be discouraged! Keep going! Per- 
sonal contact works best. I go around the wait- 
ing room introducing myself and giving out 
free materials. 

Survey respondents described other ideas for increas- 
ing class attendance and making the classes more 
effective: 

Convenient times. Some clinics offer classes in con- 
junction with clinic appointments. The Colorado pro- 
gram just mentioned rotates the day of the week each 
class is offered. In this way, a client who has appoint- 
ments on Mondays only, for example, will eventually 
have all classes in the series. The Maternity Group in 
Charlottesville, Virginia, found that morning classes 
worked best because they did not interfere with chil- 
dren coming home from school, naps, or favorite televi- 
sion programs. 

Convenient places. Making classes available out- 
side clinics is a method employed by several programs. 
Healthy Babies in Jasper, Indiana, holds classes in 




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THE PREGNANCY C.A.R.E. PROGRAM 



schools (in home economics courses) and in public li- 
braries. Local churches donated space to the Matern- 
ity Group in Charlottesville, Virginia. 

Waiting room conferences. The Patient Education 
Program of Maternity, Infant Care-Family Planning 
Projects, in New York City, provides six counseling 
sessions in clinic waiting rooms, covering 1) physiolog- 
ical and emotional changes of pregnancy, 2) nutrition, 
3) fetal development, 4) labor and delivery, 5) infant 
care, and 6) family planning. 

Food tasting/demonstration sessions. Reported by 
the Patient Education Program of the same New York 
program, these sessions combine the fun of cooking 
with nutrition education. 

• The purpose of the food tasting/ 
demonstration session is to intervene in specific 
problems noted by the nutritionist and to en- 
courage patients to prepare nutritious, low- 
cost, delicious meals in accordance with cultu- 
ral patterns," Each session is preceded by a 
nutrition discussion, and the recipe prepared 
demonstrates the principles discussed. 

Strong referral systems. Both clinics and classes 
repeatedly mentioned referrals from other agencies 
serving low-income women as a good way to recruit 
patients. The Hawaii Lamaze Association in Hon- 
olulu, for instance, mentioned the WIC and EFNEP 
programs, Welcome Baby, public health clinics, and 
well baby clinics as sources of referrals. 



24 



PRENATAL SERVICES 



Follow-up. Educational, as well as clinical, programs 
reported calling or writing women who missed classes. 

• The Comprehensive Maternity Service 
Project in Pittsburgh, Pennsylvania, wrote that 
"all women enrolled are referred for nutrition- 
al services and prenatal classes. We follow each 
enrollee to make certain she receives both. Each 
enrollee must keep the appointment or she is 
contacted." 

• Childbirth Preparation Classes in Palm 
Beach, Florida, maintains a "swap shop." Par- 
ticipants who complete all six classes are eligi- 
ble to borrow equipment and clothing from the 
shop. 

• Family Planning and Maternal Health Ser- 
vices in Clinton, Iowa, offers free gifts, donated 
by a church, to those attending a full series of 
classes. 

Individual counseling. Classes are supplemented in 
some programs by individual counseling. 

• The Pregnancy Plan program in Mobile, 
Alabama, uses a formal discussion guide to 
plan the counseling appropriate to each pre- 
natal visit. At the first visit, for instance, the 
physician discusses diet, smoking, alcohol, 
drugs, and financial concerns; at the second, 
family support is covered; at the third, physical 
activity is discussed, and so on. This system 
can be tailored to any educational level and has 
the advantage of being "especially usable in a 
group practice or clinic because multiple physi- 
cians can see the patient without loss of con- 
tinuity." 

Class discussion guide. A more elaborate guide for 
group discussion was also described. 

• The Division of Maternal Health in South 
Carolina has devised "From Here to Matern- 
ity," a series of cards. Each is headed by a 
typical patient concern, such as "How many 
drinks are too many? Is one kind of alcohol 
safer than another?" Each card outlines the 
content of the discussion — in this case, the 
reasons alcohol is not safe during pregnancy — 
suggests learning activities, and describes 
ways to evaluate the patient's comprehension. 
The 80 cards are designed for quick referral so 
that the instructor can respond to patient inter- 
ests as they are expressed. An evaluation of the 
project following the pilot test revealed that "12 
out of 14 (districts) replied that prenatal clinic 
education had changed in some way since the 
introduction of the package. The most common 
changes reported were increases in the number 
of classes and addition of topics to the curric- 



ulum. There was an increase in group classes, 
one-to-one counseling, and the use of printed 
materials." 

Prenatal mailings. Two programs reported regular 
mailings geared to the concerns and problems of each 
month of pregnancy. The ASSIST (Antepartum Sup- 
port Services) program in Holland, Michigan, sends 
out monthly brochures to prenatal clients; and the 
Prenatal Letter Program in Jefferson City, Missouri, 
mails monthly letters, along with educational materi- 
als. Although not specifically aimed at low-income 
women, these mailings, according to the Missouri pro- 
gram respondent, have been "widely accepted by low- 
income women and by middle- and upper-income 
women as well." 

Transportation, babysitting, and refreshments. 

These are all enticements, and in some cases necessi- 
ties, for class attendance. How they can be arranged 
was described by the Maternity Group in Charlottes- 
ville, Virginia: 

• Refreshments are a necessary "bonus" which 
help create a relaxed atmosphere. Although 
some supply money was available from our 
grant, local stores were willing to donate $10- 
$25 in supplies. ...Some group members also 
brought snacks and WIC staff volunteered to 
provide some snacks from their cookbook. With 
a little innovation, refreshments do not have to 
be expensive. 

• Additional support services necessary for a 
successful group are transportation and 
babysitting. Because most Health Department 
patients have few personal resources, these ser- 
vices are essential. Meeting at a church and 
having access to the nursery allows for comfort- 
able child care. Babysitters were obtained from 
University of Virginia education classes and 
the Voluntary Action Center.... 

• Although a few members provided their own 
transportation, this proved to be an essential 
support service for all members, even those liv- 
ing in the city. Fortunately, the Health Depart- 
ment driver was available. The nurse co-leader 
drove a second van and the social worker drove 
her car. Riding together helps members get to 
know each other and also gives group leaders a 
chance to hear feedback about each meeting. 

Free gifts. As incentives to attend classes, several 
programs offer free gifts: 

• The Larimer County Health Department in 
Fort Collins, Colorado, wrote: "Rather than 
serving meals at the meeting, the monies allot- 
ted have been utilized to purchase baby care 
items that are used as incentives.... Various 



25 



PRENATAL SERVICES 



companies have been contacted and asked if 
they would donate products.... At each meeting 
the women receive a small infant care item such 
as a bib, a rattle, or an American Baby maga- 
zine subscription. If the women attend five or 
more of the six sessions, they receive a 
layette.... Each time a woman attends the 
group, she has an opportunity to fill out a raffle 
ticket.... The prize is a new car seat." 



PUBLIC INFORMATION CAMPAIGNS 

A small group of survey respondents described in- 
formation and education campaigns to encourage 
women to seek early prenatal care and to maintain 
healthy habits during pregnancy. POWERLINE, in 
Atlanta, Georgia, has established a statewide toll-free 
hotline to help women obtain prenatal care and deliv- 
ery. Two other statewide programs, "Thanks, Mom," 



MARKETING PRENATAL CARE 



Many survey respondents noted that word-of- 
mouth was one of their best promotional tools. How 
word-of-mouth can be turned into an active market- 
ing campaign is described below by the East Bay 
Perinatal Council in Berkeley, California. 

The marketing of a product or service is used to 
make it stand out, either as an alternative to other 
products or services, or as a solution to a need the 
potential user did not know was available. We are 
marketing prenatal care services in both manners. 
For low-income women — at risk for having babies 
who die or are very sick — competing survival 
needs, high stress, lack of knowledge, or fear make 
healthful behavior and effective use of health care 
low priorities. We are actively competing for their 
attention through the use of promotional cam- 
paigns, door-to-door education, mass media, and 
community organizing.... 

To build a strong and effective project we are using 
the following basic tools of marketing: 

• Focus group testing of materials; 

• Creating a campaign for distributing the pro- 
motional materials which emphasizes personal con- 
tact..,. 

The actual design and form of the final materials 
will depend on the focus group results. We are test- 
ing the effectiveness of a wallet-size card which can 
be passed easily from person to person, as well as 
other kinds of "pass along" items such as pens, 
pencils, key rings, etc. Our process for developing 
these materials allows us to determine which items 
appeal most to the people we are trying to reach. 
The key will be to develop promotional items which 
will inspire people to talk to others about prenatal 
care. 

In addition to the design and production of the pro- 
motional items, effective distribution will be cru- 
cial. Again, market research studies provide two 
key guidelines for distribution: 

• Mass distribution materials can raise awareness, 



but they need to be reinforced by personal contact in 
order to lead to action. 

• Family and friendship networks are strong and 
very credible sources of health information, es- 
pecially for low-income women and teens, the 
groups most likely to enter prenatal care late. 

One clear target group for the promotional materi- 
als will be current enrollees in prenatal programs 
— they are the best advertisement to their peers 
about the importance of prenatal care and can 
speak most directly about the experience of obtain- 
ing care.... 

We will distribute the promotional items through 
existing community networks with which we are 
affiliated, and through our door-to-door effort, the 
Oakland Infant Health Project. Through a contract 
from the State Department of Health Services, we 
help staff community prevention councils in East 
and West Contra Costa County, which will provide 
access to health professionals and to concerned lay 
people to promote and distribute the materials. The 
Oakland Infant Health Project (OIHP) is perhaps 
our broadest single source of personal contact for 
the distribution of the materials. OIHP uses out- 
reach workers who are themselves from low income 
communities to go door-to-door in East and West 
Oakland to talk to residents about the problem of 
infant mortality and the need for prenatal care. A 
Tell-A-Friend card with the name of a particular 
clinic and practitioner to contact will personalize 
and enhance this process immeasurably. 

There is no single, simple solution to the problem of 
bringing women into care earlier in their pre- 
gnancies because of the many reasons women have 
for not getting into care. Each effort that is coordi- 
nated with the others, and complements them, will 
have its focus on a different group of women. We do 
know that for the sake of the babies, the children of 
the next generation, we must make every effort to 
ensure their survival and get them off to a fair start 
in life. The Tell-A-Friend campaign has been 
judged as one small way to do just that. 



26 



PRENATAL SERVICES 



in Ohio, and the Healthy Children Initiative, in Ten- 
nessee, also use a toll-free number as a contact point 
for their educational campaigns. 

Some local public information campaigns are the prod- 
ucts of coalitions: 

• Healthy Baby Week in Williamsport, Penn- 
sylvania, for example, was a cooperative effort 
of 13 agencies and hospitals. Each provided a 
segment, worked on a committee, and provided 
material. A shopping mall hosted the 3 -day 
event and provided advertising. A Healthy 
Mothers' Fashion Show, using pregnant mod- 
els, was interspersed with 5-minute presenta- 
tions by six agencies. The Junior League held a 
Baby Marathon, the March of Dimes, a 
Father's Scavenger Hunt, and the local Lung 
Association, the World's Biggest Baby Shower. 

• The Pontiac Infant Health Promotion Pro- 
gram, Pontiac, Michigan, involves several 
committees whose work is coordinated by the 
Oakland County Health Division. The com- 
mittees, representing various agencies and 
groups in the city, have developed brochures 
and posters as well as a card listing the five 
major signs of premature labor. This program 
has also promoted maternal health through 
community groups, radio and television pro- 
grams and newspapers, and conducted train- 
ing programs for professionals. 

Two others described extensive public information 
campaigns aimed at low-income women. 

• CHOICE — Concern for Health Options: In- 
formation, Care, and Education — in Philadel- 
phia operates a hotline to refer women to avail- 
able services. This program follows up on a 
certain percentage of the callers, focusing on 
teens and uninsured women. In addition to the 
hotline and a variety of promotional materials, 
CHOICE has developed special training ses- 
sions for secondary school personnel and 
special educational materials for teens. It also 
has fostered a teen theater group, the Connec- 
tion, which performs in city schools. The con- 
tent of the performances includes the im- 
portance of prenatal care, tips on keeping 
healthy, nutrition, substance abuse, and issues 
surrounding finishing school after a baby is 
born. Celebrity spokespersons help promote 
this campaign, a strategy which the program 
finds effective. Of the various promotional 
efforts, this survey respondent found that 
television news coverage and PSAs with celeb- 
rities generated the most calls to the hotline, 
followed by bus and subway cards. Word-of- 
mouth also accounted for a large proportion of 
calls. 



• Mother Care Is Baby Care, a program spon- 
sored by the Texas Department of Health, has 
developed and distributed PSAs, flyers, a 
slide-tape program, and other materials pro- 
moting early and ongoing prenatal care. It held 
a workshop for public health personnel from 
around the State and encouraged them to local- 
ize the materials. The campaign materials, re- 
ported this survey respondent, "were geared for 
low -income Texans in the following ways: 1) 
use of radio PSAs, 2) representation of Anglo, 
Hispanic, and Black populations in TV PSAs 
and the slide -tape program, 3) use of approx- 
imately 6th-grade reading level in the 
brochures, 4) use of English and Spanish in the 
posters, flyers, brochures, and slide-tape pro- 
gram, and 5) campaign promotion handled 
primarily at the local level, allowing public 
health staff to target their efforts appropriately 
in their communities. 



NEEDS FOR EDUCATIONAL MATERIALS 

Most frequently mentioned was a need for free materi- 
als with a clear message. Materials and programs 
work best, said one respondent, when they are simple 
and repetitive. Materials for specific audiences — His- 
panics, Southeast Asians, adolescents, single mothers 
— were also frequently identified as needs. Drug 
abuse and high-risk pregnancies (better risk assess- 
ment guides) were the most frequently requested 
topics, and audiovisuals (films and filmstrips), the pre- 
ferred format for many respondents. Two genetic 
counseling programs mentioned needs for materials: 
audiovisuals for middle and high school students, and 
more specific information on birth defects for the lay- 
man. Other materials requested: 

• Infant CPR brochure and choking protocol; 

• Information on stress management; 

• Material on the psychosocial aspects and benefits of 
pregnancy; 

• Smoking cessation materials aimed at low SES (tak- 
ing into account the constraints and stress of poverty 
that affect smoking behavior); 

• Good promotional materials to encourage class 
attendance; 

• Parenting information aimed at a low SES audience; 

• Table-top flip charts for patient counseling; 

• Information for businesses that do not allow time off 
for prenatal care, pointing out the hidden costs of such 
a policy; 

• An affordable general guide to pregnancy and birth 
that does not have excessive advertising. 



27 



PRENATAL SERVICES 



ELEMENTS OF SUCCESS 

Respondents repeatedly testified to the importance of 
coordination with related services in the community. 
CHOICE in Philadelphia advised: 

• Link the outreach/public awareness effort to 
a service (especially a well-known one) that can 
provide counseling and referrals to prenatal 
care. 

The need to cooperate also was expressed emphatical- 
ly by the East Bay Perinatal Council in Berkeley, 
California: 

• Networking, coordination of services, re- 
sources, meetings, a multiplicity of groups in- 
volved all work towards the common cause of 
lowering infant mortality and the incidence of 
low-birthweight babies. 

The importance of a dedicated staff and flexible, car- 
ing attitude was also emphasized by many programs. 
As the Trident Health District in Charleston, South 
Carolina wrote: 

• We believe the instructor should be warm and 
caring and show an interest in the clients so 
they will want to come back. ...We believe our 
program is successful because we include the 
clients in the discussion and are flexible in 
meeting their needs. For instance, if a woman 



is near her delivery date, we try and make 
arrangements for her to see the labor and deliv- 
ery film if she is interested. 

Making services easily accessible is crucial to their 
success, said many respondents. One way of doing so is 
to provide transportation; another is to take the ser- 
vice to the client — clinics in schools, for instance, or 
classes in clinic waiting rooms. "Decrease the number 
of places within the system patients have to go," 
advised the Oklahoma City County Health Depart- 
ment Prenatal Clinic in Oklahoma City. 

ADVICE AND OBSERVATIONS 

Other useful observations were shared by respon- 
dents: 

• Give free pregnancy tests and use the test 
verification to get WIC and Medicaid Services 
for the client. (Catholic Social Services, Port 
Huron, Michigan) 

• Use incentives, such as free baby clothes or 
supplies, to reward regular class attendance. 
(Maternity Center East, Baltimore, Maryland) 

• Devise a protocol for discerning a woman's 
financial needs; not all clients will reveal their 
need for help in this area. (Roanoke Childbirth 
Education, Roanoke, Virginia) 



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Pulaski County Chapter of the American Red Cross 



28 



PRENATAL SERVICES 



• Public and professional education should 
take place at the same time. Each group must 
know what the other is expecting. (Maryland 
Department of Health and Mental Hygiene, 
Baltimore) 

• Refine the use of market research groups for 
sampling patient responses to perinatal ser- 
vices and health education materials. (East 
Bay Perinatal Council, Berkeley, California) 

• Elements of success are: 1) development of a 
strong outreach component, 2) establishing a 
networking base targeted toward already exist- 
ing programs, 3) broadening the scope of staff 
to include low -income women, 4) giving prior- 
ity to motivation efforts and public relations. 
(For Your Baby's Sake, Washington, DC) 

• The program worked because it was the first 
in the area at a time of high unemployment, it 
marketed its services through the mass media, 
and it had an interdisciplinary planning com- 
mittee, and strong administrative backing. 
(Special Delivery Program, Flint, Michigan) 

• This program worked due to visibility. If peo- 
ple are aware of materials, they will tend to use 
them. Contact as many different groups as pos- 
sible. (Healthy Mothers, Healthy Babies 
Month, Louisville, Kentucky) 

• Community posters, radio, and TV would be 
best for announcing classes. ...A pre-test and 
post-test help to formalize the instruction. Util- 
ize a wide variety of educational media — films, 
demonstrations, props. Limit the number of 
handouts. (Thunder Bay Community Health 
Center, Hillman, Michigan) 

• It is our belief that educational and aware- 
ness programs, to be effective, must be deliv- 
ered within the context of a larger health care 
delivery program. Education and awareness, 
without services, will have limited success in 
improving pregnancy outcomes. In dealing 
with a low-SES population, the stability and 
continuity of programs is likewise essential for 
effective utilization by the target population. 
Continuity of care throughout the puerperal 
period, including written linkages with medi- 
cal institutions capable of providing antenatal 
hospitalization, labor and delivery care for 
high-risk populations and return referrals for 
postpartum and infant care, is vital in ensur- 
ing improved pregnancy outcomes. (Patient 
Education Program, Maternal, Infant Care- 
Family Planning Projects, New York, New 
York) 

DDD 



29 



POSTNATAL PROGRAMS 



5 



Postnatal 
Programs 



Teen parents, single parents, parents with low self- 
esteem, and parents with little experience in manag- 
ing their own lives; these are the target audiences 
cited most often by survey respondents describing 
their postnatal programs for low-income women. 
Health care and human services — including mental 
health services — often overlap in these programs, 
which are just as likely to be based in community 
buildings as in health care facilities. Funding for these 
programs was often reported to come from community 
organizations and social service agencies, as well as 
from State and local governments. 

Various kinds of programs fit into this category. Some 
focus on the physical needs of newborns and others 
teach life management skills for the mothers them- 
selves. But the majority of the 182 survey responses 
were from parenting programs that combine these 
concerns: teaching infant care, offering family sup- 
port, and fostering individual growth for both infant 
and parents. 

Evident in this group of survey responses was, as one 
Coalition reviewer remarked, a focus on parents as 
people. "A woman cannot be a good parent if she has 
many unmet personal needs," commented the Single 
Parents Service in Baltimore, Maryland. Goals often 
include helping parents acquire better coping skills, 
increasing self-esteem, and providing a support sys- 
tem. Frequently mentioned as goals were enhancing 
the quality of interaction between parent and infant 
and preventing child neglect and abuse. Some repre- 
sentative goal statements follow: 

• The agency has a working agreement... to 
offer services that attempt to increase bonding, 
or attachment, between new parents and their 
babies, to enhance the quality of marital and 
parental life at the time of the baby's birth, to 
increase parenting skills, and to provide an 
accessible support system. (Parent-Infant 
Growth Program, Pontiac, Michigan) 

• Some goals of the health promotion program 
are to reduce childhood injuries, increase self- 
care skills, and prevent child abuse and neglect 



by improving coping strategies. (Health Pro- 
motion Project, Albuquerque, New Mexico) 



SERVICES AND STRATEGIES 

Separating parenting programs from those that focus 
on the physical needs of infants is not easy since the 
two concerns often go together. However, some survey 
respondents, especially those based in health care faci- 
lities, are concerned primarily with infant care. 

Immunizations. This is one area of emphasis men- 
tioned by respondents. 

• Operation Baby Track, an American Red 
Cross program in New York City, focuses on 
immunization. Trained volunteers visit new 
mothers in city hospitals, giving them a list of 
clinics, a recommended immunization sched- 
ule, a receiving blanket, and a toddler's T-shirt 
printed with the immunization schedule. Tele- 
phone calls and postcard reminders are used as 
follow-up. This survey respondent uses His- 
panic and Cambodian volunteers and remind- 
er cards in Spanish and Khmer to help make 
this program work. 

• The Immunization Education Program in 
Portland, Oregon, is another Red Cross pro- 
gram. "In five area hospitals, Red Cross volun- 
teers and/or trained hospital staff meet with 
new mothers before their discharge to discuss 
the recommended immunizations.... Special 
community outreach has been targeted to 
groups working with low -income, minority, 
teen, and non-native English-speaking 
mothers. Presentations have been made within 
this target area and copies of the immunization 
materials have been made available." 

Follow-up. Other programs concentrate on keeping 
in touch with new mothers after hospital discharge. 

• The Post-Partum Phone Call Follow-Up 
Program in Florisant, Missouri, has a special 
information card attached to each maternity 



30 



POSTNATAL PROGRAMS 



patient's chart. Nurses call the mother within 2 
weeks of discharge and ask about healing of 
incisions, nutrition, rest, lochia, and breasts 
and breastfeeding. The nurse also inquires 
about the infant, answers any questions, and, if 
there is a serious problem, urges the mother to 
make an appointment. Repeat calls are made in 
these cases. This program reported less initial 
success with low-income mothers, who often 
gave incorrect phone numbers, apparently out 
of distrust. Explaining the purpose of the pro- 
gram helped decrease the number of incorrect 
phone numbers supplied on the cards. 

• Operation Baby Tracking has staff members 
visit all mothers delivering in Los Angeles 
County Hospitals, asking them to make an 
appointment, if they wish, for the baby's first 
checkup. About 85 percent keep the appoint- 
ment; others are called to see if they would like 
to reschedule. 

• The High-Risk Infant Follow-up Program in 
St. Louis, Missouri, seeks to identify all infants 
at risk in nine area hospitals, using both medi- 
cal and socioeconomic criteria. A public health 
nurse or pediatric nurse practitioner visits 
these families and refers them to health care 
and social services when appropriate. 

Support groups. Regular support group meetings 
supplement many programs, and are the primary ele- 
ment in the YWCA Parenting Program in Muscatine, 
Iowa. This program offers weekly group meetings to 
provide young and teen mothers with "self support and 
information in a long-term, support group setting." 
Membership in the YWCA is offered as an incentive to 
attract the poor, often isolated mothers in the commu- 
nity. An indicator of this program's success is that 
early participants have become facilitators of newly 
formed groups. 



STAFFING 

Staff attitudes. Staff attitudes, mentioned frequently 
by all survey respondents, were also identified as cru- 
cial to the success of postnatal programs. Repeatedly, 
a nonjudgmental attitude on the part of staff was cited 
as a goal of volunteer training and a major element in 
program success. Typical is the comment of the 
Parent-to-Parent program in Vermont: 

• We have found the preservice training has 
assisted volunteers to become nonjudgmental 
and nonthreatening to low -income parents. By 
sharing with parents rather than "directing," 
the program has been accepted by low-income 
parents in the community. 



Use and training of volunteers. Coaches, partners, 
parent-aides, or simply volunteers are terms used for 
people from the community who function as peer coun- 
selors. Use of volunteers was frequently mentioned by 
survey respondents, and their training and supervi- 
sion is an important aspect of many postnatal pro- 
grams. For example: 

• The Parent-Infant Growth Program, part of 
Oakland Family Services in Pontiac, Michi- 
gan, has "perinatal coaches" who visit families 
at home, starting in the seventh month of preg- 
nancy and continuing through the first year of 
the baby's life. Several visits are made in the 
hospital after delivery to facilitate bonding be- 
tween parent and baby. The frequency of home 
visits is determined by the family. While the 
coaches give information about maternal and 
infant care and community resources, they also 
emphasize communication between parent and 
newborn and make a special effort to include 
the father. Training for the coaches is con- 
tinuous and includes twice-a-month staff 
seminars and special consultation with ex- 
perts. This program has won the Family Ser- 
vice Association's award for the best volunteer 
program in the U.S. "It is working," wrote this 
respondent, "because of many volunteers care- 
fully trained and supervised by perinatal staff. 
The volunteer staff works in every area of the 
program. They are a strong motivational force 
for the paid staff." 

• Perinatal coaches are also a feature of the 
PAIR Perinatal Program in Alma, Michigan. 
Using procedures similar to the program de- 
scribed above, PAIR reported serving 125 
families in a little over a year and training 30 
volunteer coaches. The Michigan group had 
this advice for others: "It is extremely impor- 
tant to provide a firm training base for volun- 
teer coaches and maintain this support with 
continuing education and inservice training. 
Coaches need established support systems with 
direct guidance and supervision for specific 
case reviews." 

• Parent-to-Parent in Newport, Vermont, is a 
home visiting program for adolescent parents 
that uses volunteers selected from among the 
more experienced parents in the community, 
many of whom were teen mothers themselves. 
Modeled after the Parent-to-Parent program 
developed at the High/Scope Foundation in 
Michigan, the program provides the volunteers 
with 40 hours of preservice training and reg- 
ular inservice training sessions. State funds 
help the Northeast Kingdom Mental Health 
Service, which runs the program, pay for a 
supervisor whose guidance was found to be 



31 



POSTNATAL PROGRAMS 



crucial especially during the early visits. The 
volunteers confer with the supervisor during 
individual planning and debriefing sessions 
as well as at monthly inservice meetings. Both 
formal and informal evaluations of this pro- 
gram have been positive. Formally, an "Out- 
come Checklist/Summary" is used to collect 
data on indicators such as use of family plan- 
ning services and child immunizations being 
kept up to date. A majority of the parents 
demonstrated a significantly improved ability 
to interact with their infants. The personal de- 
velopment of the parents themselves is also con- 
sidered a mark of success; many have returned 
to work or school. 

• The PACE Program at the Allentown Com- 
munity Center in Buffalo, New York, provides 
volunteer parent -aide home visiting services to 
families experiencing or at risk for child abuse/ 
neglect. PACE recruits volunteers from the 
community to become parent-aides. After 
training, parent-aides are placed to work for 1 
year on a one-on-one basis with a family ex- 
periencing current stress. Parent-aides make 
approximately two home visits a week and offer 
telephone availability to the assigned family. 
In addition to friendship, emotional support, 
and availability, they provide parenting educa- 
tion and help in budgeting, home manage- 
ment, meal planning, job training, and educa- 
tion. Since troubled families are often socially 
isolated, it is also the role of the parent -aide to 
link families to community resources. No 
special educational background is required of 
parent-aides. Rather, PACE seeks warm, de- 
pendable, nonjudgmental men and women 
who have either knowledge of child develop- 
ment or experience in parenting. Most helpful 
are parent-aides who can empathize with the 
demands of parenting and who care not only 
about the children, but also about the parents. 
While working with a family, parent-aides re- 
ceive ongoing training and support, and a 
monthly stipend. Volunteer parent-aides cre- 
ate a caring and warm atmosphere by sharing 
their knowledge and experiences. The families 
they work with learn to trust and respond to the 
healing effects of friendship. Evidence of suc- 
cess includes a 75 percent decrease in abusive 
incidences. Some parents have entered 
educational/vocational training programs; 
some have developed and maintained appro- 
priate friendships. An increased use of commu- 
nity resources for self and children has also 
been noted. 

"A volunteer parent-aide program requires 
broad community support from professionals 



and community people in the public and pri- 
vate sector," PACE managers note. Program 
managers must be vocal and clear in their 
assertions that parent-aides are adjunctive ser- 
vice providers, ideally one part of a team which 
includes the professional counselor and pro- 
gram staff. Parent-aides and staff need to have 
realistic expectations of selves and clients. If 
volunteer parent-aides are recruited, trained, 
and accepted into the program with as much 
care as paid parent-aides, one will develop a 
competent staff. Also, program managers need 
to realize that supervision and motivation of 
volunteers differs from that of paid staff." 



e 



PERINATAL COACHES 

Perinatal coaches are trained individuals who ari 
interested and available to be a helpful resource to 
parents of a first baby. The coach has information to 
share about relating to and caring for the newborn. 

A coach tries to be sensitive, willing to listen, com- 
passionate, flexible, dependable, patient, non- 
critical, andnon-judgmental.They have the time to 
help new parents, the willingness to be interrupted 
occasionally at odd hours from a parent in distress, 
and the information about community resources 
that may be useful. 

Coaches are specially trained and supervised 
to.. ..visit parents during the last trimester of the 
pregnancy, postpartum, and during the baby's first 
year; provide parents with information and 
....demonstrate a newborn's normal responses; in- 
troduce important concepts of early childhood de- 
velopment and parenting; stress confidentiality; 
and to provide a summary of observations and 
interviews in the form of a (confidential) log for use 
in supervision. (Parent-Information Program, Pon- 
tiac, Michigan) 



OUTREACH 

Home visits by mental health workers and trained 
volunteers (as described above) are a primary tool 
many respondents use to reach their clients. Visits 
often start prior to the baby's birth and continue dur- 
ing the early months as parents adjust to new roles. 
For example: 

• The Parent and Child Center of Hawaii runs 
the Hana Like Home Visitor Program, which 
provides" a combination of child development, 
health education, counseling, and other sup- 
portive services to potentially abusive fami- 
lies." To identify "potentially abusive fami- 
lies," the program used the high-risk screening 



32 



POSTNATAL PROGRAMS 



tool developed by Drs. Harry Kepe, Ray Huffer, 
and their associates at the Colorado Medical 
Center. A paraprofessional visits these homes 
weekly to teach child development and encour- 
age positive interaction between parent and in- 
fant. Information on infant care may also be 
given. "The home visitor," according to the 
project description, "is a supportive person 
with whom the parent can build a trusting 
relationship and share family and personal 
problems." Families may call them or the pro- 
gram supervisor at any time a crisis occurs. 
Support group sessions and social activities are 
part of the Hana Like Program. 

This program has developed a simple guide to 
infant development called the Parent and Baby 
Playbook, to help parents enjoy and foster their 
baby's development. 

The Optimum Growth Project in Delray Beach, Flor- 
ida, an award-winning demonstration program that 
has been in existence for almost 10 years, uses similar 
strategies: 

• Home visitation by an assigned mental 
health worker who maintains the relationship 
with the project family over time is at the heart 
of the program. By establishing a stable and 
supportive relationship with each parent, she 
can be the vehicle through which all service is 
offered to the family. Families are visited at 
least every 2 weeks but often more frequently, 
even daily at times. The mental health worker 
uses a structured approach, based on a sequen- 
tial task curriculum. ...Evaluation, based on 
comparison with a control group, indicates 
that it is successful. Only 2.11 percent of the 
participants' infants scored below 110 on the 
Bayley Scales of Infant Development, com- 
pared to 18.68 percent in the control group. 
Fewer children in the experimental group were 
placed in foster care because of abuse or 
neglect, more mothers in this group returned to 
school or work, and fewer had recurrent births 
before 18 months. "It worked," wrote this sur- 
vey respondent, "because of strong emphasis on 
outreach, because staff remained sensitive to 
the multilingual and multicultural factors of 
the population, and because of support of staff 
and program from the sponsoring center and 
the community. 

• The Healthy Start Program in Fort Riley, 
Kansas, uses lay persons to make home visits. 
The Healthy Start Visitor acts as a "facilitator 
in assisting families to successfully move from 
having no children to having children in the 
home. The major emphasis is to educate the 
family through various means." The Visitor 
makes at least two visits during a pregnancy 
and five in the year after delivery. In addition, 
nurse supervisors visit each family at least 
twice. In-service training is held for the Visi- 
tors twice a month. 



The Pottawatomie County Healthy Start Home Visi- 
tor Program in Westmoreland, Kansas, found that it is 
more effective to visit all mothers — not just those 
designated low-income — to avoid stigmatizing any 
family. 

EDUCATIONAL PROGRAMS 

Classes. Classes teach parenting and infant care and 
often serve as support groups, too, according to several 
survey respondents. Recognizing the support value of 
classes, the Palo Alto, California Chapter of the Amer- 
ican Red Cross encourages participants to develop a 
network of their own outside the class. 

A number of hospitals have classes for women who 
deliver babies at their facilities. However, few said 
that they were targeted to low-income women, and 
several acknowledged that they had difficulty reach- 
ing these potential clients. The Baby and Me Program 
in Forks, Washington, wrote that it was "extremely 
hard to attract those people who really need the pro- 
gram... classes usually consisted of knowledgeable and 
informed mothers." One remedy this program is try- 
ing is to cooperate with WIC and Teenage Pregnancy 
Programs in the area who have been "supportive and 
eager to encourage their clients to get involved in the 
Baby and Me Program." Referrals from clinics, county 
visiting nurses, and the courts also have brought low- 
income clients to the Basics of Positive Parenting 
Classes in Elkhart, Indiana. 

In two other cases, special efforts to attract low-income 
women to parenting classes were described in detail: 

• The Infant Center in Oklahoma City reported 
that one of its major goals was to increase the 
number of low-income and less educated 
clients in parenting classes. To do this, the 
Center instituted an intense recruitment effort. 
"To reach low-income clients, Infant Center 
volunteers made on-the-floor visits at the Uni- 
versity hospital labor and delivery floors. New 
mothers, teenagers and adult, are briefly told 
about Infant Center classes, given an Infant 
Center brochure, and shown one or two fun 
things about their baby if the baby is present." 
The volunteers keep a log of who they visit and 
the interest level shown by the mother. Inter- 
ested mothers are then telephoned to confirm 
registration in a class. Other incentives — serv- 
ing food, offering an opportunity for socializa- 
tion, taking baby pictures — help keep the 
adolescent mothers coming to the classes, 
although transportation sometimes poses a 
problem. 

Several methods are being tried to evaluate the 
classes. The Adult/ 'Adolescent Parenting In- 
ventory, which assesses four factors associated 
with potential for child abuse and neglect, is 
one. Another is family drawings, which can 
help assess changes in self-esteem. In addition 
to these, weekly "I learned" statements, asking 
the teen to state something that she learned that 



33 



POSTNATAL PROGRAMS 



evening, "have proven a helpful evaluation 
technique." The Infant Center, with funding 
from the State Office of Child Abuse Preven- 
tion, has developed a volunteer training man- 
ual and a curriculum guide for use in its 
classes. 

• The Health Promotion Program at the Albu- 
querque Family Health Center in New Mexico 
is reaching low-income clients through a coop- 
erative arrangement with the WIC program 
there. As this survey respondent explained: 
"The WIC program offers the money equivalent 
of a food voucher for supplemental foods and 



PARENT AND CHILD CENTERS 

Parent and Child Centers (PCCs) are com- 
prehensive child development and family support 
centers established by the National Head Start Pro- 
gram to serve children under age 3 and their fami- 
lies. This is a multipurpose program for low-income 
families, including pregnant women and their chil- 
dren. All PCCs provide: 

• Activities for the very young child (0-3 years) 
designed to stimulate his or her cognitive, emo- 
tional, and physical development to maximum 
potential. 

• Comprehensive health care for the young child 
and his/her family and education in family health 
matters of the parents. 

• Early intensive attention to nutrition needs and 
counseling, as well as prevention of nutrition- 
related deficits caused during pregnancy. 

• Social services for the entire family. 

• Assistance to parents in overcoming economic 
and personal problems in order that they may be 
freer to function effectively as parents. 

Among the 36 PCCs in the United States are var- 
ious models; new and different approaches are en- 
couraged. Centers responding to the survey de- 
scribed free developmental daycare with parent in- 
volvement required, free transportation to and 
from the Center, support groups, and home visits. 
The PCC in Newark, New Jersey, is cooperating 
with the Seton Hall School of Nursing; student 
nurses will conduct the Denver Developmental 
Screening at the Center and provide a family life 
program. An evening parent group for fathers is 
sponsored by the PCC in Dalton, Georgia. (Com- 
plete descriptions of two PCC programs, the Hana 
Like Home Visitor Program and the PACE pro- 
gram are given elsewhere in this Chapter.) 

"PCCs and Head Start are excellent for stimulating 
preschool age children in any socioeconomic stat- 
us," wrote the director of the PCC in Leitchfield, 
Kentucky. "It could be duplicated anywhere and be 
successful." 



formula and requires that enrollees attend reg- 
ular (nutritional) classes. The addition of 
health promotion topics to the typical nutrition 
format has improved the total nurturing skills 
of parents. Many parents are reached who 
would not ordinarily attend classes of this 
kind." Courses have been designed for well 
baby care, injury prevention, and toddler 
stress. A volunteer WIC mother has translated 
some materials into Spanish. The Program 
also has developed "Winning Ways to Talk to 
Young Children," a simple explanation, with 
examples, of the most effective ways to handle 
typical daily interactions with toddlers. 

Life management. Several survey respondents re- 
ported efforts that focus exclusively on "life manage- 
ment" — the needs of the parents to establish goals 
and direction for their own lives. A good example of 
such a program's objectives was given by Child and 
Family Services in Knoxville, Tennessee: 

• Goals are self-sufficiency and support; objec- 
tives include development of 1) long-range 
child care plan, 2) high self-esteem, 3) employ- 
ment, 4) a personal friend, 5) a corporate men- 
tor, 6) a peer-support group, 7) adequate nutri- 
tion, 8) childcare and disciplinary skills. 

Two other survey respondents provided details of their 
programs' operation. 

• Adults in Transition, in New Kensington, 
Pennsylvania, is targeted to adults over 18 who 
head households. A 5-week workshop, includ- 
ing sessions on values clarification, assertive- 
ness, and resume writing, is supplemented by 
individual counseling and support groups. A 
minimal charge daycare facility is available. 
Evaluations by clients, a large majority of 
whom are below poverty level, have been favor- 
able; 70 percent have either secured employ- 
ment or enrolled in schools. "We watch our 
clients come to us," wrote this respondent, "con- 
fused, scared or insecure and leave with goals, 
plans, and confidence which enable them to be 
happier people and better mothers." 

• The Parent/Child Center in Middlebury, 
Vermont, offers, among many programs for 
low -income women, a Parent Stipend Pro- 
gram. Twenty-six weeks long, the course be- 
gins with 2 weeks of orientation to child de- 
velopment and work etiquette, followed by 20 
hours per week of course work, support group 
meetings, and on-the-job training. A 6-month 
apprenticeship with another agency is the 
second part of this program. Participants re- 
ceive a small stipend to cover their expenses. 

Home study. Families on the Grow, a Cooperative 
Extension Service project at the University of Arkan- 
sas in Pine Bluff, has created a home study course in 
parenting for Jefferson County residents. The five- 



34 



POSTNATAL PROGRAMS 



SELECTED MATERIALS 

"The Parent Express: A Month by Month 
Newsletter for You and Your Baby." Sent to new 

Earents each month through the first year of the 
aby's life, this "newsletter" or series of fact sheets 
tells parents what to expect at each new stage of 
development. The fact sheets are written on the 4th 
to 6th grade reading level, according to the Human 
Relations Program at the University of California 
Cooperative Extension Service in Berkeley, where 
they were developed. Regular features include 
"Games Babies Play" on infant stimulation and tips 
to cope with parental stress. The abundant illustra- 
tions include photographs of Black, Hispanic, and 
White women and their babies. 

"Hugs 'N' Kids." This videotape offers parents 
alternatives to physical punishment. It presents 13 
problems commonly encountered in daily interac- 
tion with preschool children. After viewing each 
vignette, parents can join in small groups to discuss 
the problem presented. They are then shown three 
or four possible endings for the vignette, some effec- 
tive and some ineffective. The San Fernando Valley 
Child Guidance Clinic in Northridge, California, 
which developed this videotape, has conducted 
some evaluation of it, indicating "a trend towards a 
decrease of predictors of abusive parenting, a statis- 
tically significant decrease in punitive responses, 
and a statistically significant increase in coopera- 
tive responses." (Editor's Note: The videotape is 
available for sale and for rent.) 



lesson course, advertised extensively in the media and 
by word-of-mouth, has reached approximately 370 
parents each year, 17 percent of whom have been be- 
tween the ages of 16 and 18. County Extension home 
economists grade the lessons and present a certificate 
at the end of the course. 



NEEDS FOR EDUCATIONAL MATERIALS 

The most frequently expressed need of survey respon- 
dents was simply written (4th to 6th-grade reading 
level), brief and clear materials on infant and child 
development, the role of parents, and basic parenting 
skills. Educational materials geared to specific au- 
diences were the next most frequently mentioned 
need. Films on parent-child relationships that reflect 
ethnic minorities in urban settings; materials for par- 
ents of children with special needs and for adoptive 
parents; materials for single parents; injury preven- 
tion materials in Spanish; and materials on parenting 
in Spanish and Asian languages: all these were listed 
by survey respondents as materials that they would 
like to see developed. One Parent-Child Center said 
that there was a need for a parenting curriculum for 
birth through 3 1/2 years. 

Two respondents wrote that they needed materials 
that could help with the evaluation of programs. An- 



other mentioned a need not for materials, but for con- 
tinuity. There is too much program fragmentation and 
duplication of services, said this respondent. "We need 
to continue doing the same service in the same place 
for the same group of people with the same agency." 

FAMILIES WITH SPECIAL NEEDS 

Children with disabilities, physical, emotional, or 
mental, have special needs, as do their parents. As one 
survey respondent pointed out, many families do not 
survive as a unit when they have to deal with a child 
who has a disability. 

Pilot Parents of Northeastern Minnesota in Duluth, 
offers one-to-one emotional support for these parents 
when they are not ready for group interaction. The 
counseling is provided by volunteers — parents who 
themselves have children with special needs. 

Other special needs programs responding to the sur- 
vey included the Early Childhood Intervention Pro- 
gram in Austin, Texas, a statewide project that funds 
62 local programs; the Aural Rehabilitation Parent 
Education Series in San Diego which provides parent- 
ing classes for mothers and fathers of hearing- 
impaired infants; and the Infant Stimulation Program 
in Richmond, Texas, which works with children under 
age 3 with developmental delays, teaching them and 
their parents both at home and in special centers. 
Three other programs were described in some detail: 

• Project ABC (Any Baby Can), in San An- 
tonio, Texas, is a model clearinghouse that 
links handicapped and high-risk young chil- 
dren and their families to the help they need. 
Over 100 social service and health care agen- 
cies are networked with Project ABC. Project 
staff provides speech screening, financial 
assistance, babysitters for handicapped chil- 
dren, parent support groups, life support 
equipment, and more. Over 600 young children 
from throughout South Texas have been helped 
since ABC's creation in 1983, including chil- 
dren who are delayed in development, mentally 
retarded, physically handicapped, or emotion- 
ally disturbed; premature and at risk for prob- 
lems; or families of children who are ill with 
serious diseases or disorders. 

• The Neonatal Parent Education Program is 
an educational program for parents of infants 
based in the neonatal intensive care unit at 
Children's Hospital in San Diego, California. 
Its objectives are to provide parents with learn- 
ing opportunities during their infant's hospital- 
ization; introduce positive methods of interac- 
tion for improving nurturing and care giving 
skills; provide information regarding commu- 
nity resources; provide opportunities for par- 
ents to interact with other parents undergoing 
similar experiences; and prepare parents for 
discharge home with their infants. Parent 
group meetings are held during evenings in the 
hospital. A resource library and free babysit- 
ting are provided. The group discusses a new 



35 



POSTNATAL PROGRAMS 



topic each week, and offers films, demonstra- 
tions, or crafts. 

• Another approach is the Early Intervention 
Network (EIN) , in Concord, New Hampshire, a 
"statewide coalition of programs, pro- 
fessionals, and parents interested in improving 
the quality of services for very young, handi- 
capped, or at-risk children and for families." 
The network works to enhance communication 
among professionals, assure appropriate train- 
ing, share resources, influence public policy, 
and disseminate current information. A news- 
letter, statewide directory, lending library, and 
conferences are among its services. 

PASSENGER SAFETY PROGRAMS 

Maternal and child passenger safety is a health issue. 
Commented one Coalition member who reviewed sur- 
vey forms describing child safety seat programs, "It is 
a law in all 50 States and the District of Columbia and 
is part of a comprehensive health program." Most 
passenger safety program staff responding to the sur- 
vey represented statewide programs operated by 
State highway safety offices. These are directed to all 
parents, not just low-income families. The problem 
they address is concisely stated by the California 
Highway Traffic Safety Program: Among children 1- 
14 years of age, traffic accidents are the leading cause 
of death. The proper use of child safety seats could 
reduce deaths by 90 percent and injuries by 70 percent. 
The use of these seats by low-income families is de- 
pendent on loaner programs, some of which are de- 
scribed below. 

The Alabama Department of Public Health, Child 
Restraining Program is one example of a statewide 
program. With the objective of increasing the usage 
rate to 26 percent by October 1985, promotional efforts 
have been conducted through various channels, in- 
cluding the media, medical communities, businesses, 
schools, and community organizations. Loaner pro- 
grams are conducted through local health de- 
Eartments, and a model comprehensive program for 
lead Start Centers has been developed. Through 
these promotional efforts, the use of child restraints 
increased from 7.9 percent in June 1980 to 22.6 per- 
cent in October 1984. 

Other survey respondents described various strat- 
egies for making their programs more effective. 

Networking. Coalitions, networking, and coopera- 
tion among public and private organizations were 
mentioned frequently by the statewide programs. In 
New York, for instance, the Child Restraint Loaner 
Project for Low-Income Families held extensive 
education programs "to coordinate with local health, 
motor vehicle, police, and other groups; while con- 
sultations took place to aid development of new sites 
(for loans) statewide." The KISS (Kids In Safe Seats) 
program in Ohio conducts an education and seat loan- 
er program primarily through hospitals and has an 
extensive volunteer network. This survey respondent 
commented: 



• Implementing such a program takes a full- 
time coordinator to get it off the ground. Feder- 
al funds are available in most States to assist 
such programs. The continuance of the pro- 
gram does depend on the volunteer organiza- 
tions and network set up throughout the State. 
Assisting volunteers and keeping their interest 
in the program is a key factor in the success of 
the program. 

Convenient loan sites. Reaching low-income parents 
often means making the loaners and educational 
materials available at convenient sites, according to 
several survey respondents. Washington's Traffic 
Safety Commission, for instance, distributes materi- 
als through health departments, WIC sites, and mi- 
grant health clinics. The Red Cross's Operation Child 
Saver Program in Miami loans seats for a nominal fee 
and at five different sites. Pediatric Group Services at 
the Medical College of Pennsylvania, most of whose 
clients receive welfare, offers a rental program and 
education sessions in its waiting room. 

Evaluation of programs. Data from several States 
indicate that these programs are working. In Ala- 
bama, use of child restraints increased from 7.9 per- 
cent in June 1980 to 22.6 percent in October 1984. In 
Georgia, rates rose from 17.7 percent before the State 
law was passed to 29.7 percent after it was passed. In 
Florida, the Operation Child Saver Program of the 
Red Cross reports that in 1984, 10 children under age 5 
not wearing seatbelts were killed, and 1,796 injured. 
This figure is compared to only 2 children killed and 
727 injured among those who were wearing seatbelts. 

Educational materials. Ranging from PSAs to 
bumper stickers, educational materials have been 
produced by a number of State highway safety 
programs and national consumer organizations. 
Guides for community groups developing seat belt 
promotion programs have been prepared by the KISS 
program in Ohio and the California Highway Traffic 
Safety Program. Other audiovisual and print 
materials are distributed by the National Highway 
Traffic Safety Administration, American Academy of 
Pediatrics, National Child Passenger Safety 
Association, American College of Obstetricians and 
Gynecologists, and child safety seat manufacturers. 

ORAL HEALTH PROGRAMS 

A number of oral health promotion programs for chil- 
dren, nearly all located within State health de- 
partments, responded to the survey. Most of these 
Erograms distribute educational brochures and tooth- 
rushes. Some operate fluoride supplement programs 
in schools and clinics. The Well Child Clinic — Pre- 
ventive Dental Health Program in Maine's Depart- 
ment of Human Services provides fluoride drops and 
tablets, toothbrushes, and parent dental health educa- 
tion materials to non-Medicaid families visiting Well- 
Child Clinics throughout the State. (Fluoride supple- 
ments are available through Medicaid.) The free 
fluoride supplements have been provided to approx- 
imately 800 children in less than a year of operation. 



36 



POSTNATAL PROGRAMS 



One of the few nongovernmental dental programs 
responding to the survey is administered by the Col- 
lege of Dentistry at the University of Iowa. This pro- 
gram provides information and treatment to infants 
and children, especially "those who are inaccessible to 
treatment because of developmental disability, age, 
distance, and financial status." Beginning with educa- 
tion in the prenatal period, dental services are pro- 
vided for those with known dental disease or who will 
be at high risk for dental disease; a sliding fee schedule 
is used, and indigent children are not charged for 
treatment. 

Dental education materials. State programs have 
produced a variety of print materials on dental health. 
For example: 

• A poster on baby bottle tooth decay, by the Well 
Child Clinic-Preventive Dental Health Program in 
Maine. 

• Brochures in both English and French, by the same 
program. 

• A handout for all maternity patients, by the Tennes- 
see Department of Health and Environment, Dental 
Division. 

• A brochure on fluoride supplements, by the Fluoride 
Supplement Program in West Virginia. 

• An Oral Health Teaching Guide for the Mother and 
Child, developed by the Texas Department of Health 
in Austin. 

AMERICAN RED CROSS PROGRAMS 

The Red Cross has developed several health education 
programs, including Parenting Your Child from 1 to 6, 
and Better Eating for Better Health. Local Red Cross 
chapters responding to the survey are using the 
national programs, but some have developed materi- 
als or techniques adapted to a specific target audience. 
For instance: 

• The Hispanic Outreach Program of the Ore- 
gon Trail Chapter in Portland, Oregon, has 
translated materials into Spanish and trained 
bilingual instructors. An Hispanic Communi- 
ty Needs Assessment has provided information 
from which an action plan will be developed for 
the next 2 years. 

• Parenting — Preparation for Parenthood, in 
Portland, Maine, is adapting its program for 
those who read at the 4th to 6th grade level and 
for teenagers. 

• Parents Helping Parents, in Asheville, North 
Carolina, teaches parenting courses in schools, 
maternity homes, and to clients of the Depart- 
ment of Social and Protective Services. 

• The Pulaski County Chapter in Little Rock, 
Arkansas, has developed an infant CPR course 
for high-risk infants, adapted from the tradi- 
tional Red Cross course. Responding to a need 
expressed by many area physicians, this chap- 



Cardiopulmonary Resuscitation 
for Sustaining an Infants Life 





f$v$ 




Pulaski County Chapter of the American Red Cross 



ter worked with a local hospital and the Junior 
League to develop an infant CPR program. The 
program has trained volunteers to teach the 
2 -hour course to parents before they go home 
from the hospital with their baby. The Chapter 
has also developed a manual for infant CPR. 

Other Red Cross programs are described in the 
Educational Programs section. 

ELEMENTS OF SUCCESS 

Whether their chief concern was parenting, infant 
care, special needs, passenger safety or oral health, 
these programs repeatedly cited certain elements of 
success: networking; community support; community 
involvement in planning; and a well-trained, well- 
supervised volunteer and professional staff. 



37 



POSTNATAL PROGRAMS 



,■ . ■ 



CONSIDER CLIENT NEEDS 







Before they are ready for a traditional parent 
education program, clients have more immediate 
needs: 

• a change of scene; 

• to be with adults/peers; 

• to feel warm and cared for; 

• to feel like an adequate person/parent. 

Meeting these needs contributes to improved par- 
enting. A mother who feels nurtured will be less 
angry. Given a chance to exchange ideas and be 
endorsed by peers, she will increase her coping 
skills and act with more confidence. If she feels 
competent, she will have less need to exert de- 
structive power. 

Be cautious, however, about group programs. 
Large, structured discussion groups (over four) may 
be risky business for clients who feel inadequate 
and inarticulate. Loosely structured "social" occa- 
sions will more effectively motivate clients. In an 
inviting place with people, food, and child care, 
clients can relax and learn through observation. 
They are being "readied" for learning. 

In time, natural clusters will begin to emerge with 
matched pairs or groups of three that would work 
well together. More structured programming with 
short term contracting around various topics of 
child rearing then become viable. 

(From the Parent Educator, New York Foundling 
Hospital, New York, New York. Copyright 1984) 



not take home until the 6 weeks of classes are 
finished. (Infant Center, Oklahoma City, Okla- 
homa) 

• Serve food of some type at classes; this helps 
retain class members. "It's a combination of the 
food and socialization." (Infant Center, Okla- 
homa City, Oklahoma) 

• Plan to involve community members in all 
stages of planning, implementation and 
evaluation of the program. (Hispanic Out- 
reach, A mericanRed Cross, Portland, Oregon) 

• Hold Healthy Baby Fairs at low -rent housing 
projects. Include educational displays and 
handouts; nurses to answer questions and give 
demonstrations; a story corner; exercise in- 
struction; a crawl contest; balloons and 
clowns; a dentist; and police to (ID) fingerprint 
children for parents. Each month go to a dif- 
ferent low -rent housing project. (American 
Red Cross, Knoxville, Tennessee) 

• Provide incentives for parents to participate 
in classes such as baby bibs (with program 
messages), a baby-sitters guide, a booklet for 
siblings. (Newborn and Parent Supports, 
Hastings, Nebraska) 



IDEAS AND OBSERVATIONS 

• Operate a "warmline," making support and 
counseling available through telephone con- 
tacts. (Positive Parent Network, Rapid City, 
South Dakota; Parent -to -Parent, Newport, 
Vermont) 

• Provide transportation to the class. This is 
very important as well as is an inter- 
disciplinary approach. (Preschool Parenting 
Program, Cleveland, Ohio) 

• Child care must be assured for mothers who 
cannot provide it themselves (and will other- 
wise bring children to class). Midmorning ses- 
sions (10 a.m. - noon) seem to be most effective. 
Classes should be limited to groups of 8. (Tide- 
lands Dental Health Center, Savannah, Geor- 
gia) 

• To keep teens coming back to classes, take 
pictures of parents with their babies and mount 
them on the cover of baby books, which they do 



DDD 



38 



COMPREHENSIVE PROGRAMS 



6 



Comprehensive 
Programs 



Representing community clinics, hospitals, social ser- 
vice agencies, local health departments, and home 
health agencies, 510 survey respondents provide 
"comprehensive" care to low-income families. What 
these programs have in common — from the perspec- 
tive of this survey — is the commitment to serve low- 
income women through the prenatal, perinatal, and 
well into the postnatal periods. Many also offer infant 
care and health services to women between 
pregnancies. 

Often located within established agencies, these pro- 
grams reported their funding is obtained through the 
sponsoring organization's budget, supplemented by 
Federal, State, and local government support. A size- 
able proportion have operated for more than 3 years; 
almost all have conducted a community needs assess- 
ment or a form of evaluation or patient tracking. Their 
clients are women of all ages from many different 
ethnic backgrounds. 

Respondents from comprehensive programs respond- 
ing to the survey fit into three groups: those based in 
health care facilities, those in social service agencies, 
and those in local health departments. Within health 
departments, Early and Periodic Screening, Di- 
agnosis, and Treatment programs are a significant 
subgroup. 



SERVICES AND STRATEGIES 

Health care facilities. Comprehensive maternal and 
child health care is provided by freestanding primary 
care clinics and by ambulatory care units attached to 
hospitals. Their services usually include the tradition- 
al prenatal checkups and laboratory tests, postpartum 
checkups, and infant care. Some survey respondents 
described extensive auxiliary services, including 
dental work, nutrition counseling, social services, and 
tuberculosis screening and management. 

The Sunset Park Family Health Center in Brooklyn, 
New York, a clinic serving a largely Hispanic popula- 
tion in one of 16 poverty areas of New York City, 
typifies a comprehensive program. 



• Prenatal care is a complete and adequate 
health program prescribed for pregnant 
women which protects and promotes their total 
physical health and emotional well-being 
while providing for the needs of the growing 
fetus. Toward this end, comprehensive services 
are offered which employ medical management 
as well as health promotion/ disease prevention, 
dentistry, public health nursing, nutrition, in- 
cluding WIC, and social services. ...All pre- 
natal patients seen in the Health Center are 
assured delivery at Lutheran Medical Center 
and are referred to the admitting office for bed 
reservations in the seventh month of preg- 
nancy. 

Continuity of care does not cease for the Health 
Center prenatal patient upon admission to the 
hospital. All Family Health Center newly de- 
livered women are admitted to the postpartum 
unit for a stay of 2 -3 days. During this time, the 
patient is exposed to a multiplicity of health 
education experiences and materials... A 2- 
week postpartum visit appointment is also 
given to the woman at this time. ...All newborn 
infants of Health Center patients are seen by a 
board-certified neonatologist. Graduates of the 
nursery are given appointments in the newborn 
service within 2 weeks. 

Another feature of this comprehensive program 
is the clinic's schedule: it is open from 8 a.m. to 
9 p.m., Monday through Friday and has 
Saturday drop-in hours from 10 a.m. to 6 p.m. 
It also allots a full hour for the first prenatal 
visit "to allow for personal, quality care in an 
unhurried atmosphere." 

Social service agencies. Social service agencies 
responding to the survey provide information and 
support for pregnant women and mothers with 
infants. Counseling and referrals are often major 
components of these programs. A good example is 
Pregnancy Aid of Snohomish County in Everett, 
Washington, which wrote: 



39 



COMPREHENSIVE PROGRAMS 



• We provide services, or assistance in obtain- 
ing services from appropriate sources, for the 
emotional and physical well-being of expectant 
mothers and their babies. Our services also 
include information and support in setting life 
goals. Many of the people we see, particularly 
teenagers, have low self-esteem, a poor image of 
themselves, and little understanding about 
how to plan their lives or set either short or 
long-term goals for themselves. 

Free, strictly confidential help concerning 
pregnancy and related questions is available 
through Pregnancy Aid at its office and over 
the telephone on a 24 -hour basis... 

Our support activities include layettes for new- 
born babies; child care to help mothers; preg- 
nancy testing; loaned baby and maternity 
clothing; and a variety of educational material 
on parenting, baby care, and motherhood. We 
also provide emergency supplies of baby food 
and formula; emergency housing; prenatal 
vitamins; public information programs for 
schools and community groups; plus problem- 
solving assistance for clients who get caught up 
in red tape difficulties or similar situations 
with other community services. 

Local health departments. Reducing infant mortal- 
ity and the incidence of low birthweight are the goals 
most often stated by city and county health de- 
partments responding to the survey. Characteristics 
of these comprehensive programs include: multiple 
sites for delivering care; clinic services offered as stag- 
gered or block appointments; and close cooperation 
with other agencies. In addition to basic health care, 
these programs offer a vast array of ancillary services, 
from education and nutrition to parenting courses and 
sessions to increase self-confidence and self-esteem. 
Examples of ancillary services follow: 

• Birthright Pregnancy Care Center in 
Hastings, Nebraska, is a social service agency 
whose goal is "to provide assistance to those 
women who face an unplanned pregnancy. We 
work on a one-to-one basis, trying to provide for 
each client an environment that will produce a 
healthy full-term child. We encourage early 
medical care and followup to see that the client 
is keeping appointments." This agency also 
addresses problems of abuse, housing, 
education, clothing, transportation, and legal 
aid. It uses volunteers. "We feel that the 
program is successful," wrote the director," 
because by becoming a friend on a one-to-one 
basis it is easy to identify a client's real needs, 
and we are able to address these needs. We 
know that the clients are better equipped to 
provide parenting with close support systems." 



• The San Bernardino County Department of 
Public Health's Maternal Health Program in 
California offers ancillary services, including 
nutrition and psychosocial counseling and 
health education in conjunction with the direct 
medical services provided by the private physi- 
cians in the community. This special project is 
a forerunner for implementation of the Margo- 
lin Bill in California, which allows MediCal 
reimbursement for ancillary perinatal services. 
This health department also provides direct 
health care services and home visits. The 
Maternal Health Program has received two 
National Association of Counties Awards "for 
its special programs to address the particular 
needs of low-income women in the County." 
(Spanish-speaking Maternal Health Care 
Project, 1983, and Home Birth Follow-up Pro- 
gram, 1984) 

• The Worcester County Prenatal Clinic in 
Berlin, Maryland, provides routine prenatal 
services with one exception: if the patient comes 
in early and regularly she will get reduced 
rates for services. 

• The Wake County Health Department and 
Medical Center in North Carolina has assess- 
ment tools for prenatal home visits so the labor 
and delivery doctors can better understand the 
home situation. Other assessment tools are 
used for patients at risk for preterm delivery 
and for postnatal home visits. Each is printed 
on one page (both sides), and is comprehensive, 
problem oriented, and clear. 

• Many health departments provide speakers' 
bureaus with the traditional subjects covered: 
reproduction, family planning, sexually trans- 
mitted diseases' signs and symptoms, and pu- 
berty. Some have trained staff to give work- 
shops in Parent Effectiveness Training, La 
Leche League standards, or Lamaze tech- 
niques. The Memphis (Shelby County) Health 
Department in Tennessee includes assertive- 
ness training among the speeches offered, 
teaching teens to understand that they can say 
"No." Their brochure, "Saying No," reflects 
this emphasis. Other trends address self- 
esteem reinforcement and life-planning skills 
for low -income women. 

• The Memphis (Shelby County) Health 
Department in Tennessee has also developed 
education sheets for pregnant women with poor 
reading skills. It provides community 
education through bus cards and billboards. 

EPSDT. Early and Periodic Screening, Diagnosis, 
and Treatment (EPSDT) is a free screening and treat- 



40 



COMPREHENSIVE PROGRAMS 



merit program for all Medicaid recipients under the 
age of 21 (under 18 at State option). Many State health 
departments that administer the EPSDT programs 
responding to the survey describe services that 
include a developmental assessment, a complete 
physical, vision and hearing screening, nutritional 
assessments, and immunizations. Follow-up 
treatment is provided for any problems discovered in 
the screening process. 

Aggressive promotion of EPSDT is characteristic of 
the responding programs. All of them disseminate 
brochures or flyers explaining their services, and some 
have additional materials, such as the Maine pro- 
gram's pamphlets on dental screening. Other EPSDT 
programs are described under Outreach in this chap- 
ter. Options for use of EPSDT funds to finance the care 
of pregnant women and children are discussed in 
Appendix B. 



STAFFING 

As with specialized programs, survey respondents 
report a mix of professional, paraprofessional and 
volunteer staffing. Some examples follow: 

• With funds from the Preventive Health 
Services Block Grant, the Healthy 
Mothers-Healthy Infants program in the 
Cleveland, Ohio, Health Department has hired 
and trained Community Health Outreach 
Workers (CHOWs). The CHOWs "act as a 
friend during the change from pregnancy to 
parenthood," providing answers to nonmedical 
questions. The CHOW brochure reads: "You 
may need information on any of the following: 
food, clothing, shelter, prenatal care, school, 
county welfare, utilities, and many other ques- 
tions related to you and your baby. You will be 
assigned your own CHOW who may visit you at 
your home, the hospital or Medical Center." 

• The Caldwell Health Department in Lenoir, 
North Carolina, is starting a "grandmother" 
program to support women, especially teens, 
through their pregnancies. The grandmothers 
make home visits, provide education on healthy 
pregnancy practices, and transport patients to 
clinics and to referral places. These "grand- 
mothers" encourage the teenagers to stay in 
school, and work with their mothers on im- 
proving nutritional intake. 

• The Port Angeles Health Department in 
Washington State employs a perinatal project 
coordinator. She or he keeps patients coming 
back and provides coordination for the patients 
as they go through the health department sys- 
tem (from planning to obstetrical care to well- 
child care). He or she knows each patient by 



name and keeps up with each one, while sup- 
port personnel provide services. 

One-to-one counseling. Several survey respondents 
mentioned individual counseling as an effective way 
to inform and educate their clients. 

• Vida y Salud Health Systems in Crystal City, 
Texas, offers a birth center that provides in- 
dividual counseling at each visit of its clients, 
who are mostly low-income. This approach has 
successfully reduced complications due to high 
blood pressure. Breastfeeding is also promoted 
aggressively in this center, being required for 
those who wish to deliver in the birth center 
and encouraged for those who deliver in the 
hospital. A home visit is made, if desired, to 
help new mothers get started. 

The Team Approach. Several respondents wrote 
with enthusiasm of a team approach to caring for and 
educating their clients. 

• "An excellent approach to high-risk preg- 
nancies and care for the infants," wrote the 
Maternal and Infant Care Clinic in Salt Lake 
City, Utah. The multidiscipline team approach 
is very important to address the total needs of 
the family. Evaluation of this program showed 
that the perinatal mortality rate in its high-risk 
population is lower than that of the low -risk 
population at large in Utah. In this case, a team 
consists of 16 different specialists, including a 
health educator, a maternal nurse coordinator, 
and foster grandparents. 

• The Beaufort -Jasper Comprehensive Health 
Services in Ridgeland, South Carolina, uses 
the same team in all its clinics to provide pre- 
natal, postpartum, and intrapartum care. As 
evidence of success, it has seen a decrease in 
perinatal morbidity in the two counties. 

• The Kaiser Foundation Health Plan in Hon- 
olulu provides outreach services "by teams con- 
sisting of health coordinators and visiting 
nurses. The health coordinators enroll mem- 
bers in the program and make services access- 
ible to them; visiting nurses provide medical 
care and health education in members' homes 
....the outreach team approach is effective in 
providing continuity of care and health educa- 
tion; the team approach increases members' 
awareness of the importance of maintaining 
good health, and encourages independent re- 
sponsibility for health care." 

OUTREACH 

Comprehensive programs devote substantial time and 
resources to outreach activities. Some of the 
approaches used are described below: 



41 



COMPREHENSIVE PROGRAMS 



• Operation Telephone Granny in Macon, 
Georgia, is one of several such programs 
throughout the country funded through a 
Federal Maternal and Child Health grant. In 
Macon, the grannies are "a group of 14 caring 
women who have been trained as outreach 
workers. Many are grandmothers or mothers 
who have raised or are raising families of their 
own." The Macon-Bibb County Health Depart- 
ment hired and trained the surrogate grand- 
mothers to call and counsel pregnant women. 
Calls are made twice a month, once to remind 
women of their prenatal appointments and 
once to ask if there are any concerns or prob- 
lems connected with the pregnancy. The gran- 
nies work from home, and each calls about 25 
clients. This health department plans to have 
the grannies conduct a survey to determine 
health needs and attitudes for future program 
planning. Evaluation, although not yet com- 
plete, shows that missed appointments de- 
creased by over 21 percent in 6 months. 

• Operation Stork in Washington, D.C., a coop- 
erative, public education project of the March 
of Dimes andB'naiBrith Women (BBW), spon- 
sors Healthy Baby Fairs in shopping malls. A 
new program focus of Operation Stork is the 



workplace, in conjunction with an established 
March of Dimes project entitled "Good Health 
is Good Business." 

"We will add a new BBW twist by adapting our 
Healthy Baby Fairs for use in the business 
place. The aim of this program is to educate 
women in the childbearing years, as well as 
future fathers and grandparents, on how to 
have a healthy baby. The format of the program 
can be lectures or discussion groups on such 
things as drug abuse, alcohol and pregnancy, 
nutrition, etc., with booth displays, au- 
diovisual presentations and a healthy snack 
counter. The possibilities are endless! The 
March of Dimes has an abundance of educa- 
tional materials for our use. These programs 
can take place during the lunch hours or end of 
shift." 

EPSDT programs also reach out to their clients. For 
example: 

• The EPSDT Outreach program in Nashville, 
Tennessee sends letters to eligible clients offer- 
ing assistance with transportation and 
scheduling. 

• The EPSDT program in Nevada developed a 
colorful, simple booklet using very large print 



AN URBAN INITIATIVE 



The Mayoral Initiative to Reduce Infant Mortality 
in New York combines many of the strategies de- 
scribed here in a city-wide, comprehensive pro- 
gram. It is, first of all, a public information cam- 
paign. Subway and bus advertisements, television 
and radio PSAs, posters, flyers, and wallet cards 
promote healthy habits during pregnancy and the 
use of health services. They also inform the public of 
some of the Initiative's other components, which 
include: 

• Pregnancy Health Line, a call-in service for in- 
formation and referrals. Callers can make prenatal 
appointments through the Health Line at one of the 
60 participating health facilities in New York. The 
Health Line is staffed by four operators, two of 
whom are bilingual in Spanish and English. The 
operators follow up on callers and for those who do 
not keep their appointments, attempt to help over- 
come obstacles to prenatal care. 

• Women's Health Program, a community based 
health education program. This program employs 
Public Health Educators, based in areas of the city 



where infant mortality rates are especially high, 
whose sole responsibility is outreach. 

• Mini-Departments of Health, located in six dif- 
ferent areas of the city, which identify, track, and 
follow up high-risk patients. 

• Child Health Passport, a booklet that is mailed 
out with all birth certificates. This entitles any 
child without health insurance to receive free im- 
munizations and preventive services for the first 18 
months of life. The Passport is designed to serve as a 
medical record as well, to be kept by the mother. 

• Adolescent Reproductive Health Services, a pro- 
gram which pulls together and augments existing 
teen services. In addition to traditional medical ser- 
vices, this program offers career planning and peer 
group counseling. All services are provided in the 
late afternoon, early evening, or on weekends. 

• Prenatal Program for Pregnant Addicts, which is 
designed, like the teen program, to coordinate exist- 
ing services, in this case prenatal and addict care, so 
that continuity and follow-up is assured. 



42 



COMPREHENSIVE PROGRAMS 



to explain the benefits of the service. This pro- 
gram also sends out a card explaining the pro- 
gram with assistance checks. 

Home services. Taking health services directly to the 
client is an outreach strategy used by a number of 
health departments. Two examples follow: 

• The Lyon County Community Nursing Ser- 
vice in Marshall, Minnesota, although it relies 
primarily on classes for health education, 
makes home visits to women who do not attend 
the group sessions. A public health nurse dis- 
cusses prenatal, postpartum, and parenting 
topics on a one-to-one basis, a method that this 
survey respondent has found effective. "They 
(the clients) have to learn specific things, e.g., 
Lamaze breathing, because the public nurse 
will quiz them at the next visit. Women inter- 
ested in breastfeeding have a chance to work 
with the public health nurse on a private basis. 
This seems to work best for the Agency and 
results in the best retention of information..." 

• The Hamilton Home Health Agency in Har- 
risburg, Pennsylvania, supplements Hamilton 
Health Center's physician services by making 
home health visits to women in the prenatal 
and postnatal periods, and to all children 
under the Center's care. A public health nurse 
or a qualified community health worker under 
the close supervision of the nurse makes the 
visit. This Agency has developed a checklist of 
topics to be discussed at home visits printed on 
one side of an 8 1/2" x 11" sheet of paper, on the 
reverse of which is space to record monthly data 
on the physical checkup, such as weight and 
blood pressure. 

Information by telephone. Several comprehensive 
health care clinics mentioned 24-hour telephone 
accessibility as one of their services. New York has a 
call-in service, described under "AN URBAN INITIA- 
TIVE" (see box). Telephone referral services were re- 
ported by two programs. 

• The Healthy Mothers, Healthy Babies Coali- 
tion of Erie County in Buffalo, New York, has 
established a hotline, TLC-BABY, for mothers 
who need information and referrals. Promot- 
ion and publicity were essential parts of this 
program. "One-time public relations doesn't 
work," said this survey respondent. A separate 
public relations committee publicizes the hot- 
line and the Coalition's other programs. 

• The Primary Care Council in St. Louis, Mis- 
souri, has set up a centralized telephone refer- 
ral service for the area's community health cen- 
ters. "This phone number is being used on all 
publicity.... distributed to the community at 



large, as well as to unemployed individuals 
through unions or other large mailings. 
Through this central referral mechanism, a 
caller's needs are identified, and she is given 
general service information and referred to the 
closest Center. 

Summarizing the importance of persistent, aggressive 
outreach efforts, the Parent-Child Center in Balti- 
more, Maryland, urged others to "go out into the 
schools and communities. Don't wait for them to come 
to you." This clinic maintains a speakers' bureau of 
health professionals who visit classrooms of local 
schools. It also provides preventive health and educa- 
tional programs for daycare centers. The Maternal 
and Child Health Program in Arlington, Virginia, 
reported that "use of outreach workers has increased 
the Department's Maternity Clinic admissions by 50 
percent." 

Networking. Outreach can also be interpreted to 
mean active liaison with many other community 
agencies serving low-income families. The importance 
of networking — for continuity of services, for refer- 
rals, for patient tracking, and for retaining the patient 
in the health care system — was emphasized repeated- 
ly by survey respondents. Some health care programs 
reported cooperative arrangements with social service 
agencies, and some social service agencies said they 
had agreements with health care providers. Here are 
two examples: 

• The Elizabeth General Medical Center's Out- 
patient Clinic, which provides complete pre- 
natal, postpartum, family planning, and 
pediatric management for indigent patients in 
the eastern Union County area of New Jersey, 
has a social worker interview prenatal patients 
at one of the first visits. The Social Service 
Department has an excellent relationship with 
community agencies, especially the Division of 
Youth and Family Services. Contact is made 
with them immediately... all women are re- 
ferred to the WIC Program. Elizabeth General 
Medical Center has a contract affiliation with 
neighboring hospitals. Psychiatric crisis inter- 
vention is available when necessary and 
follow-up is also provided. A genetics service 
operates within the hospital. Women and their 
families are referred when appropriate. 

Networking relationships are also useful to 
this program when patients fail to keep their 
appointments. "If the patient does not then re- 
turn (after reminder cards), the public health 
nursing department in Elizabeth or the Visit- 
ing Nurse Service is notified to visit the patient 
at home. The community agencies have in- 
formation on these clients beforehand because 
a referral form is processed for each new pre- 



43 



COMPREHENSIVE PROGRAMS 



natal patient for home evaluation and health 
care supervision. This assists us in acquiring a 
more complete picture of each client and her 
individual strengths and weaknesses." And 
this survey respondent noted "Our delinquency 
rate is much lower than in years past because of 
efficient chart review and cooperation of com- 
munity agencies." 

• The Ripley County Health Coalition in 
Osgood, Indiana, is a volunteer organization 
that offers screening, support, and referrals to 
low -income women and their families. The 
Coalition has agreements with area health pro- 
fessionals who provide prenatal screenings 
and well-child physicals at monthly clinics. 
After initial pregnancy tests and blood work, 
the patients are referred to continuing prenatal 
care. Referrals are also made to "other area 
services that can aid in the overall well-being of 
the family, whether it is physical, emotional, 
financial, or spiritual." 



EDUCATIONAL PROGRAMS 

Health Education classes were mentioned by a num- 
ber of survey respondents in this, as in most other 
categories. Two programs described their recruitment 
strategies: 

• The San Antonio Neighborhood Health Cen- 
ter Perinatal Program in Texas has a "Prenatal 
Care and Delivery Agreement" which includes 
a section on classes. It reads, in part, "These 
classes are so important that they are required 
of all our patients. If you don't want to come to 
these classes, tell the social worker im- 
mediately. You may wish to drop out of our 
program or enroll in classes somewhere else. If 
you fail to attend the classes, we are not bound 
to deliver your baby, and will transfer your 
prenatal records to another doctor of your 
choice." As a result of its Perinatal Program, 
this clinic reported increased utilization by all 
racial groups and a decrease in the number of 
complications. 

• The Sixteenth Street Community Health 
Center in Milwaukee, Wisconsin provides edu- 
cational services that are geared to the cultural 
background of its patients and promoted ac- 
cordingly. "We include prenatal education 
classes in English, Spanish, and Hmongl 
Laotian; a car seat rental program specifically 
geared to low-income and non-English read- 
ing Clients; and a parent support! education 
group geared to low-income and low educa- 
tionally achieving families of newborns to 
toddler -aged children. All educational services 



are provided without charge and are specifical- 
ly geared towards low -income and minority 
families by the type of promotional campaigns 
utilized, selection of material to be included in 
class content or handouts, and through the pro- 
vision of translation services to the two largest 
minorities of patients that we serve — Hispanic 
and Indochinese." 

The large numbers of returning parents and of 
parents bringing friends testifies to the success 
of the approach. This clinics' incidence of low 
birthweight surpasses that of Milwaukee 
County as a whole. 

NEEDS FOR EDUCATIONAL MATERIALS 

Although there were more respondents in the com- 
prehensive category than in any other, fewer needs for 
educational materials were identified, perhaps be- 
cause these programs have had better access to exist- 
ing material and tend to cooperate more closely with 
other agencies and groups serving the same clientele. 
Needs expressed tended to be quite specific, however. 

Several respondents cited a need for programs that go 
beyond basic health education to teach self-sufficiency 
and employment skills. Another requested a model for 
programs that emphasize allied health professional 
staffing. Yet another need, apart from client materi- 
als, is for staff development and training aids. Pro- 
grams on teen pregnancy and promotion of immuniza- 
tion for infants of low-income women were also re- 
quested. 

Foreign-language materials were given high priority 
by several respondents; their "wish lists" included: 
Asian-language materials, particularly Chinese, 
covering basic maternal and infant care; Spanish 
materials on prenatal care; illustrated handouts on 
family planning for non-English-speaking and illiter- 
ate clients; and materials on pregnancy and infant 
care for mentally retarded parents. 

Specific topics requested were: accident prevention; 
budgeting for young families; exercise; discomforts of 
pregnancy and how to deal with them; nutrition; high- 
risk pregnancy; personal hygiene; substance abuse; 
oral health; and normal responses of newborns. 

Information for target groups, such as single and teen- 
age mothers and fathers — particularly adolescent 
fathers — and Black teenagers are also needed, 
according to survey respondents. 

Recruitment materials to encourage clients to seek 
prenatal care and to promote attendance at classes 
were requested by one respondent, who said: 

• I would like to have a guide to learn how to 
effectively recruit patients for obstetric classes. 
The turnout is low, and I don't know how to 
bring up attendance. 



44 



COMPREHENSIVE PROGRAMS 



This need was implied often, if not frequently stated, 
by many respondents when reporting rates of at- 
tendance at health education classes. 

Popular materials that have gone out of print are 
sorely missed, and respondents specifically requested 
some of these. Titles identified were: "Thinking About 
the Baby? Thinking About Breastfeeding?" produced 
by the Texas WIC Program; the Centers for Disease 
Control's booklet on amniocentesis; and a simplified 
version of "Little Babies Born Too Soon, Born Too 
Small," or an equivalent publication on prematurity. 

Audiovisual materials were frequently mentioned by 
respondents working with clients with low literacy 
levels. Requested were films about premature labor, 
delivery, and teen pregnancy; slide-tape presentations 
on all health topics; and an up-to-date childbirth film. 
One respondent cited the need for an audiovisual 
series of childbirth education classes for use in under- 
staffed clinics. 

ELEMENTS OF SUCCESS 

Comprehensive programs were more likely than re- 
spondents in other categories to have statistical evi- 
dence of success. For example: 

• The Hobbs and Lovington Health Depart- 
ment in Hobbs, New Mexico, instituted a clini- 
cal Prenatal Program, with the objectives of 
lowering the infant mortality rate and reduc- 
ing the number of women who do not seek 
health care until delivery. Before the Prenatal 
Program the "walk-in" rate at a local hospital 
(for women who were about to deliver but who 
had not had prenatal care) was 28 percent. 
This was reduced to 5 percent. Similarly, the 
neonatal mortality rate has declined from 25 
percent to below 5 percent. 

• The Maternal Child Health program in Lex- 
ington, Kentucky, which emphasized a com- 
munity system of health care delivery, has 
lowered the infant mortality rate. "The death 
rate has been reduced from 12 percent in 1982, 
to 9.8 percent in 1983, a 2.2 percent improve- 
ment in 1 year as a result of this comprehensive 
maternity health care system. This was done 
even though, during the same period of time, a 
study released (in 1983) by the Southern Re- 
gional Task Force on Infant Mortality reported 
that Kentucky had the 15th highest mortality 
rate (11.6 percent) among the 50 states and the 
District of Columbia. The Fayette County rate 
also surpassed the national rate of 10.9 percent 
in 1983. 

• The Indian Health Center of Santa Clara 
Valley in San Jose, California, aims to in- 
crease the accessibility of services to Native 
Americans and other low -income women and 



children in the county. It reported that "our 
prenatal program has outreached and pro- 
vided services to many low -income women who 
have needed extra time and attention focused 
on their medical care and their psychosocial/ 
economic concerns. In 1983, 5 percent of our 
prenatal clients were Native Americans; in 
1984, 89 percent were either Native American, 
Southeast Asian, or Hispanic." 

Survey respondents emphasized several important 
elements of success: networking, sensitivity to cultu- 
ral needs, and a good staff. These were effectively 
summarized in the Watts Health Foundation's survey 
response for its Community Perinatal Direct Services 
in Los Angeles. 

Consider hiring local community individuals 
when developing your case management 
staff.... Hire individuals throughout the pro- 
gram who reflect the cultural ethnic and lan- 
guage differences in the community. Emphasis 
should be placed on hiring bilingual staff as it 
increases patients' acceptance, as well as com- 
fort with the program services. 

Work collaboratively with other resources 
within your agency and in the community. De- 
velop inter- and intra-agency agreements and 
referral mechanisms which will support effi- 
cient service provision to patients and will 
assist each program! agency in meeting its 
stated goals and objectives. 

Be very conscious not to be impatient when 
implementing the program or making a sig- 
nificant change in its operations. Follow your 
work plan, revise as needed. Allow 2 to 3 
months for the change to occur and another 2 to 
3 months to work through related issues and 
challenges. 

Become familiar with other programs provid- 
ing similar services in the area. Avoid duplica- 
tion of services. Open communication and then 
sharing of strategies (i.e. forms, policy, pro- 
cedures, etc.) which have been proven to be 
effective in one location, could be useful in their 
application to your program as well. 

Encourage ongoing in-service training and an- 
nual certification for your staff.... as perinatal 
health care is an evolutionary field. When seek- 
ing training for staff , contact: junior/ local col- 
leges; hospital-based training programs, par- 
ticularly those developed for labor and de- 
livery; perinatal nursing staff; and family 
planning organizations, as these programs are 
usually offered at a good price, and provide 
recognized certification in the subject areas 
and the opportunity to interface with other per- 
sonnel performing similar tasks. 



45 



COMPREHENSIVE PROGRAMS 



USING FILMSTRIPS 

Filmstrips can be good motivators for discussion 
and present valuable information. However, using 
them effectively is not a simple matter. They gener- 
ally reflect idealized middle-class settings, and 
often present too many ideas using complex lan- 
guage. Nevertheless, they are good program aids. 
To use them: 

• Select some titles to preview. Then choose one 
strip that best addresses your topic. 

• Be creative in your selection; for example, parents 
of toddlers may want to discuss "discipline." A film- 
strip on toilet training could teach those concepts 
within a particular context. 

• Read the discussion guides and decide in advance 
what to say and ask about the presentation. 

• Decide whether to show all of it or just look at a 
few frames to get discussion started. Will you play 
the tape or narrate, rewording the script yourself? 
Or, just use the video and let the client(s) tell what 
is happening. 

• Be alert to viewers. Stop the filmstrip to clarify or 
note for later discussion that a particular point cre- 
ated some reactions. (From the Parent Educator, 
New York Foundling Hospital, New York, NY. 
Copyright 1984.) 



ADVICE AND OBSERVATIONS 

• It takes a long time to get new programs es- 
tablished — no matter how worthwhile they 
are. Utilize new ways to advertise new pro- 
grams. Try to appeal to all marketing groups. 
Even if a program does not start with a big 
bang, don't give up, try again, try new pro- 
motional techniques. Don't give up. (Johnson 
County Community Health Services, Warren- 
burg, Missouri) 

• Review your program regularly and modify 
it, if necessary, according to social trends. One 
service agency wrote, "The program has been 
traditionally geared to adoption, but, as single, 
pregnant women are increasingly raising their 
children, the focus has shifted to parenting 
issues and support services for single -parent 
families." (Catholic Charities of Pittsburgh, 
Pittsburgh, Pennsylvania) 

• Emulate the private sector and other coun- 
tries in providing facilities to which our clients 
are not ashamed to go for services. Allow space 
for privacy, provide a cheerful atmosphere with 



soft music and reading materials to remove the 
feelings of second-class health care services. 
(Polk County Health Department, Winter 
Haven, Florida) 

• Staffing is the key to success. ...The physician 
staff changes with coverage, etc., but if the 
patients see the same nursing staff consistently, 
they feel comfortable. They keep their appoint- 
ments, follow instructions, and take their 
medications. (San Bernardino Community 
Hospital Obstetrical Center, San Bernardino, 
California) 

• Many health department people grow 
apathetic, lose courage after any length of 
health department employment. Nurses, social 
workers, health educators, clerks, aides, out- 
reach workers, and doctors should support 
each other more positively. (Charles City Coun- 
ty Health Department, Charles City, Virginia) 

• Combine WIC services with the first prenatal 
visit to get patients in early. (OB/GYN Clinic, 
Greenville, South Carolina) 

• Find financial subsidy for the prenatal care 
and the hospital charges. The cost is one of the 
most threatening aspects of care that keeps 
patients away. Arm patients with as much in- 
formation as possible. Advocate for them at the 
hospital. They need your support. (Parent- 
Child Center, Baltimore, Maryland) 

• Offer free or inexpensive pregnancy tests to 
get patients into early prenatal care. (Elizabeth 
General Medical Center, Elizabeth, New 
Jersey) 

• Our tracking system which is tied in with our 
educational program as well as medical care is 
unique.... Careful orientation, commitment 
through a written contract, early follow-up, 
assistance with transportation and finances 
are crucial features of our success. (West Ala- 
bama Health Service, Eutau, Alabama) 

• Apply for as many Federal and State grants 
as possible. (Erie County Health Department, 
Buffalo, New York) 

• In the Mexican-American culture, the hus- 
band is the autocratic figure. ...In low-income 
families, success will be achieved by directing 
education to the husband-father. (Urgent Sup- 
plemental Assistance, McAllen, Texas) 

• A program such as ours requires much pub- 
lic promotion within the community (churches^ 
schools, etc.). Coordinate class schedules and 
notify health care professionals to increase re- 
ferrals. (Louisville Memorial Primary Care 
Center, Louisville, Kentucky) 



46 



COMPREHENSIVE PROGRAMS 



• Give the public something tangible and free, 
like well-child examinations. Give health and 
human service providers something tangible 
and free, like a resource directory and/or a tele- 
phone I&R hotline. (Healthy Mothers, Healthy 
Babies Coalition of Erie County) 

• At classes, raffle gifts, baby clothes, milk, 
and literature packages. (Martin Luther King 
Clinic, Homestead, Florida) 

• Operation Stork, based in Washington, D.C. 
has layette incentive programs in many com- 
munities throughout the country. Originally a 
support service — giving layettes to needy 
mothers — the program now puts a new empha- 
sis on the layette concept. "We no longer simply 
give away baby clothes and items to expectant 
mothers. We use these layettes as incentives to 
get the very necessary prenatal care.... Women 
who routinely get prenatal care at a hospital or 
clinic are given vouchers when their babies are 
born and they can go to a 'Stork's Nest' and 
exchange those vouchers for layette items. 
These vouchers give them an incentive to get 
prenatal care." (Operation Stork, Washington, 
DC) 

• Hold a family health fair, enlisting "full com- 
munity support — mayors, all agencies, news 
media." (Healthy Mother, Healthy Baby Fami- 
ly Fair, New Kensington, Pennsylvania) 

• Offer fitness classes for expectant mothers 
and for new mothers with infants. (YMCA of 
the USA, You and Me Baby, St. Paul, Minne- 
sota) 

• Offer a baby-sitting coop, a playmate connec- 
tion, a clothing swap. (Parent-Child Center, 
Baltimore, Maryland) 

• Offer separate classes for single mothers who 
may feel uncomfortable in classes with couples. 
(Our Lady of Providence Children's Centers, 
Springfield, Massachusetts) 

• Low -income patients often have low self- 
esteem and are hesitant to stand up for their 
rights with health professionals. It helps the 
patient if our nurses write instructions for the 
patient when sending her to the hospital. If 
communications break down, the patient has 
written evidence that a public health nurse has 
made arrangements for her and the patient is 
indeed following the instructions given. (Wake 
County Health Department and Medical Cen- 
ter, North Carolina). 



DDD 



47 



BREASTFEEDING 



7 



Breastfeeding 



Use of volunteers, little or no funding, and enthusiasm 
characterize the 28 breastfeeding promotion programs 
responding to the survey. Often conducted by mothers 
who have successfully breastfed, these programs seem 
to possess a sense of mission. Few receive Government 
or foundation funding; church donations, client contri- 
butions, and "none" were the answers most frequently 
given under "funding sources." 

But enthusiasm, patience, and sensitivity were evi- 
dent in the survey replies. "Our program works," 
wrote the Pocono Mountain La Leche League, which 
serves low-income women in Tobyhanna, Pennsyl- 
vania, "because we do not force the issue, but gently 
encourage. We publicize our services well and follow 
through on all inquiries. A larger percentage of 
women at local hospitals are beginning breastfeeding. 
We are there to help them continue." And the volun- 
teer leader of the La Leche League in Kansas City, 
Missouri, which serves only low-income women, 
wrote: "I believe we had a commitment and a vision at 
the beginning of our program that has continued to 
this day. We wanted to initiate this kind of low-income 
group for a long time...." 



SERVICES AND STRATEGIES 

A combination of educational presentations, suppor- 
tive counseling, and community outreach efforts is 
typical of programs that encourage breastfeeding. A 
variety of methods was described. For example, the 
Community Advisors for Breastfeeding (CAB), Lex- 
ington, Kentucky, provided this description of its his- 
tory, goals, and the challenges confronted in its day-to- 
day activities. 

• Recognizing the need for offering services 
similar to those of the La Leche League pro- 
vided by women who represent minorities, 
working women, single parents, or economical- 
ly disadvantaged families, the Kentucky De- 
partment of Human Resources, Lexington, 
Kentucky, organized the Community Advisors 
for Breastfeeding Mothers (CAB), an associa- 



tion of women with lactation experience who 
advised and encouraged other mothers inter- 
ested in breastfeeding. As this respondent re- 
ports, "Two Anglos and six Black women and 
six of their husbands participated during the 
first 3 years in outreach and counseling activi- 
ties. An inquiry into the local Community Ac- 
tion Program led us (the Department) to a 
group of friends who had shared knowledge, 
books, and experiences about breastfeeding 
with each other previously. They, in turn, re- 
cruited other advisors to the program." 

Several formative meetings were held with a 
health educator from the Lexington -Fayette 
County Health Department on the organization 
and scope of the group as well as training 
needs, and plans were made for a formal train- 
ing session, which consisted of a 6 -hour session 
led by the health educator and a La Leche 
League leader, that was repeated twice for new 
members. CAB mothers were trained in 
counseling techniques, advantages of 
breastfeeding, solutions to common breastfeed- 
ing problems, and other aspects of lactation. 
Each had a reference manual containing pro- 
gram policies and a variety of La Leche League 
information sheets on problems. 

We established a referral system with several 
programs serving pregnant mothers including 
the University of Kentucky obstetrics out- 
patient clinic, a private hospital maternity pro- 
gram, a private birthing clinic, and a health 
maintenance organization. The majority of re- 
ferrals, however, came from the WIC and 
maternity programs of the Lexington-Fayette 
County Health Department. 

Some of the mothers counseled in the CAB pro- 
gram called for technical information about 
lactation, but most were searching for basic 
information about lactation and encourage- 
ment to breastfeed. In addition to telephone 
counseling, CAB mothers made home visits 



48 



BREASTFEEDING 



and mailed written materials to interested 
families... appeared on televison and radio 
interview shows, staffed displays at health 
fairs, and led discussion groups at community 
agencies... CAB organized a 1 day workshop 
for people interested in breastfeeding, and ap- 
proximately 60 pregnant women and three of 
their husbands attended; ten of the women 
were teenagers. The agenda included audience 
participation quizzes and discussions on the 
benefits of breastfeeding, techniques of 
breastfeeding, and special concerns such as 
Caesarean sections and premature births. 
Other unique aspects of the workshop included 
a panel of men discussing ways fathers can 
support the lactating mother. Transportation 
for participants and lunch (donated by mer- 
chants and local businesses) as well as work- 
shop registration were provided at no charge. 

During the past several years, advisors have 
come to recognize several principles and strate- 
gies that guide their promotional activities. 
First, knowledge about breastfeeding benefits is 
not enough.. .Opposition from friends and 
relatives, especially a husband or boyfriend, 
can create serious doubts about the value of 
lactation, interfere with the let-down response, 
and lead to insurmountable problems. Advi- 
sors need to assess the amount of antagonism 
and support a woman will face if she decides to 
breastfeed and use the information to help the 
woman decide if breast or bottlefeeding is the 
best option for her. In some cases, encourage- 
ment from friends or a CAB member may be 
sufficient to overcome the criticism, skepticism, 
and hostility of other network members... CAB 
advisors were particularly cautious in their 
promotion of breastfeeding when the mother's 
husband or boyfriend was unyielding in his 
opposition... in all cases, CAB advisors pre- 
sented bottlefeeding as' a viable alternative so 
that a mother who found lactation intolerable 
was not left with an unacceptable option associ- 
ated with feelings of guilt and failure. 

Second, the male's role in the lactation experi- 
ence is often overlooked... male advisors also 
participated in television interview shows and 
other promotional activities. By addressing 
men's concerns, they did what the female advi- 
sors could not: transmit the message that men 
accept breastfeeding. 

Third, the opportunity to reach large numbers 
of individuals through mass media should not 
be overlooked. Television, newspapers, and 
radio offer a highly influential, relatively in- 
expensive means of reaching large numbers of 



people. One way to get on the air... is to seek 
invitations to talk shows as nutrition or infant 
feeding advisors and then make breastfeeding 
the dominant topic. Fourth, education of 
mothers should begin long before the last 
trimester of pregnancy... CAB, therefore, at- 
tempted to establish referral networks that 
allowed a breastfeeding or infant feeding advi- 
sor to work with a woman as early in her preg- 
nancy as possible. 

But, CAB was not without problems. Among 
those cited was the volunteer status of CAB' s 
membership, which caused practical problems. 
Since all but one of the CAB mothers were 
employed on a full-time basis, they had to con- 
duct program activities during the evenings or 
weekends. This delayed recruitment of addi- 
tional CAB mothers, training of advisors, out- 
reach activities, and the number of advisors 
available for telephone and home visitation 
counseling. In addition, CAB mothers were 
unable to maintain private telephone service 
continuously, so their phone numbers changed 
frequently and promotional materials became 
outdated. Moreover, budget constraints... pre- 
vented the installation of a single-line tele- 
phone with call- forwarding capacity that 
would have enabled calls to be received on a 
24 -hour basis from advisors' homes or a cen- 
tral office. In addition, without funding, it has 
not been possible to thoroughly evaluate the 
program's actual impact on the incidence or 
duration of breastfeeding. This, in turn, made 
it difficult to convince health agencies to refer 
clients to CAB or rely on CAB advisors for 
in-service training of the professionals who 
work with women during pregnancy. Funding 
currently is being sought to remedy this de- 
ficiency. Organizers remain upbeat about the 
program, however, observing that even without 
additional funds... CAB has already demon- 
strated the feasibility of building a social sup- 
port and information network for economically 
disavantaged mothers who would like to 
breastfeed their babies. 

Other strategies were also reported by groups around 
the Nation. 

Prenatal counseling. Because most women decide on 
their infant feeding method before the baby is born, 
programs introduce the concepts and techniques of 
breastfeeding in the prenatal period. In Brownsville, 
Texas, for instance, the La Leche League-City Clinic 
Program gives classes at the Brownsville Maternity 
Center at 28 and 34 weeks of pregnancy. Two volun- 
teer mothers who work half a day a week at the clinic 
give separate classes in Spanish and English. Another 



49 



BREASTFEEDING 



program, the Pocono La Leche League in Tobyhanna, 
Pennsylvania, distributes literature and provides 
speakers to WIC sites and prenatal clinics. 

Hospital visits. Counseling new mothers during 
their hospitalization is a technique used by several 
programs including the Travis Park Infant Nutrition 
Program in San Antonio, Texas, and the Maternal 
Infant Care Program at the Medical College of Penn- 
sylvania in Philadelphia. For mothers whose babies 
must remain in intensive care, the Unified LaCrosse 
Region Infant Intensive Care Program in LaCrosse, 
Wisconsin, encourages breastfeeding and has de- 
veloped a booklet called "You Can Provide Breast 
Milk for Your Hospitalized Infant." 

Telephone support. This technique is mentioned by 
several survey respondents. The Pocono Mountain La 
Leche League in Tobyhanna, Pennsylvania offers tele- 
phone counseling on a 24-hour basis. A hotline has 
been established by the Henry J. Austin Health Cen- 
ter in Trenton, New Jersey, as part of its com- 
prehensive Breastfeeding Support Program, which 
uses most of the techniques described here. The Mater- 
nal Infant Care Program at the Medical College of 
Pennsylvania, uses active telephone follow-up, com- 
menting that: 

• The counselors know from their own experi- 
ence that they need to reach out to these women, 
call them frequently, rather than just be there if 
they called. If the counselors waited, they (the 
mothers) would rarely call. 

A Boston University research study on telephone 
counseling, the Randomized Controlled Trial to Pro- 
mote the Duration of Breastfeeding, has tested the 
effectiveness of scheduled, routine telephone contacts 
and a 24-hour hotline in a low-income population. This 
survey respondent reported that evaluation data 

• showed marginally significant trends in 
favor of the intervention. The intervention 
appears to work while it is operating (i.e., the 
first 2 weeks) but once counseling ends, rates 
even out. These results supported our claim 
that a longer intervention period is necessary to 
establish successful breastfeeding in our target 
population. 

This program reported that it is now trying to use lay 
community counselors from the inner city. 

Buddy system. The Wisconsin Nutrition Program 
(WNP) in Madison trains as counselors volunteers 
who have breastfed and pairs them with mothers who 
want advice and support. All counseling is done by 
telephone, and WNP has prepared a booklet (in Span- 
ish and English) on "Starting a Telephone Support 
System for Breastfeeding Mothers." 



Support groups. These are at the heart of the La 
Leche League International (LLLI) program, a nation- 
al group with many local chapters. Nearly half of the 
survey responses in this category came from local 
League chapters. Volunteers lead La Leche support 
groups, which usually meet in participants' homes. 
Format and materials are supplied by the national 
office. The La Leche League has developed materials 
in over two dozen languages on many different aspects 
of breastfeeding and parenting, and these were fre- 
quently mentioned by survey respondents, both affili- 
ates and nonaffiliates of the League. But the LLLI 
Headquarters in Franklin Park, Illinois, noted that 
materials need to be developed for a lower 
educational-level audience. The League is beginning 
to receive more and more information requests from 
low-income women and the professionals working 
with them. 

STAFFING 

Most breastfeeding promotion and support services 
are provided by nurses, nutritionists, physicians, and 
other members of the health care team as a part of 
prenatal, postpartum, and infant health care. Volun- 
teer and paid peer counselors are also being used to 
provide mother-to-mother support. 

Using volunteers. Volunteers, according to survey 
respondents, conduct support groups, make home and 
hospital visits, and provide telephone counseling. How 
one volunteer program got started and how it works is 
explained in detail below: 

• The staff of the clinic has been frustrated over 
the years at the number of women who begin 
breastfeeding while in the hospital and switch 
to formula before the first clinic visit. ...We had 
always made available to our mothers the 
names of existing support groups. However, 
they never seemed to use them. These groups 
are generally made up of middle-class 
mothers. 

In the spring of 1983, a social worker suggested 
that one of our more enthusiastic nursing 
mothers be sponsored to attend a nursing 
mothers' counselor course. With funds donated 
by our local Ross (Laboratories) representative, 
we paid for the training of a WIC mother 
....Four more women completed the training 
course, and the program was in full swing by 
the late fall of 1983. The initial trainee is the 
leader, providing the coordination we do not 
have time for. They have taken the program on 
as their own, naming it the "Doula Nursing 
Mothers." The word "doula" describes a 
woman who supports a new mother in the first 
few months in all aspects of child care, but 
particularly feeding. The counselors use the 



50 



BREASTFEEDING 



clinic staff for information, continued training, 
referrals, and fund raising support. We use 
them to do a job we are unable to do, due to the 
lack of time (and probably cultural distance). 

The women spend most ofl day per week in the 
hospital, speaking with women in the prenatal 
clinic, visiting new mothers on the maternity 
floor, and conferring with hospital staff. Meet- 
ings are held every 2 weeks to provide support 
for nursing moms and to educate pregnant 
women about what to expect from the nursing 
experience. Much of the supportive counseling 
is done on the phone when the counselors call to 
check on their clients. They also make home 
visits as needed. 

(From the Maternal Infant Care Program, 
Medical College of Pennsylvania, Philadel- 
phia, Pennsylvania) 
Paid community workers. The Infant Nutrition 
Care Project in Brownsville, Texas, used church fund- 
ing to hire and train bilingual community representa- 
tives, women who had successfully breastfed, to lead 
classes. 

Cooperation with other agencies serving low- 
income women. Several La Leche League chapters 
have reached low-income women by cooperating with 
clinics, WIC programs, and teen pregnancy programs. 
The chapter in Paterson, New Jersey, for instance, 
gives talks to inner city hospital staffs and to adoles- 
cent pregnancy programs. The Newark, New Jersey, 
chapter receives referrals from WIC and prenatal cli- 
nics. One chapter reported a program aimed ex- 
clusively at low-income women. 

• The Kay Cee La Leche League group meets 
monthly at the Wayne Minor Health Center in 
Kansas City, Missouri. "We function with a 
group discussion based on LLL meeting out- 
lines and the immediate needs of the partici- 
pants attending. The nutrition department at 
the Center directs mothers to our group who are 
considering breastfeeding their babies. We 
keep in touch with the mothers in addition to 
the Center's follow-up." The group has main- 
tained its continuity for 4 years (while turnover 
of the Center's paid staff is high). "Thus we 
have repeating mothers who come back to the 
Center and the group and can share their expe- 
riences with the new mothers in the group." 

• Communication with the Center's staff has 
been important to this program. "The staff has 
also learned about breastfeeding from us and 
has started a second class. We meet with the 
staff several times a year to evaluate our prog- 
ress or to discuss concerns. The communica- 
tion between the staff and La Leche League 
leaders remains very good." 



NEEDS 

Educational materials. Survey respondents from 
breastfeeding programs did not mention the need for 
materials as often as respondents in other kinds of 
programs. However, La Leche League International 
headquarters did note a lack of materials for a less- 
educated audience. One respondent said free, easy-to- 
read materials were needed. And two respondents 
mentioned the need for a slide-tape or video on how to 
begin breastfeeding in the hospital. 

Institutional policies. Many needs expressed were 
administrative or logistical. "Not only do we need to 
educate the mothers, but also the OB nurses on the 
floor plus implementing policies on the OB ward that 
complement the breastfeeding couple," wrote the coor- 
dinator of the Breastfeeding Classes at St. Mary's 
Medical Center in Evansville, Indiana. 

Professional education. Health and social service 
professionals need more information on breastfeeding, 
according to the Wisconsin Nutrition Project's survey 
of WIC Project Directors. Support for this finding is 
supplied by the SPRANS Breastfeeding Project in the 
Bronx, New York. It reported that breastfeeding in- 
creased in three Bronx municipal hospitals from about 
25 percent to about 40 percent as a result of a "multi- 
disciplinary approach (including) professional educa- 
tion, assistance in developing new institutional policy 
toward breastfeeding and patient material for specific 
populations." 



ADVICE AND OBSERVATIONS 

Respondents shared these observations and sugges- 
tions based on their experiences: 

• The key to being successful is to appeal to 
each woman's desire to do the best she can for 
her baby. Women respond to other women who 
are themselves mothers. ..but breastfeeding is 
an Art that does not come naturally to most 
women. Those who are successful are usually 
supported by other nursing mothers. These 
basic needs can bring women of very different 
socioeconomic backgrounds together. (La 
Leche League of Newark, South Orange, New 
Jersey) 

• Promotion of breastfeeding involves more 
than providing "proper" information for in- 
formed choice. It also involves ensuring the 
necessary support and time -dependent practi- 
cal skills for success at breastfeeding.... For a 
comprehensive approach to breastfeeding pro- 
motion one obviously needs a prenatal, per- 
inatal, and postpartum program that ad- 
dresses structural and personal barriers in the 
health care system. (Random Controlled Trial 



51 



BREASTFEEDING 



to Promote Breastfeeding Duration, Boston, 
Massachusetts) 

• Develop a broad base of support within the 
community. Invite health professionals and 
consumers to serve on an advisory task force. 
Find a strong base to house the program, such 
as a WIC program. Hire a coordinator (20 to 40 
hours a week) whose sole responsibility is the 
program. Ask for a 1-year commitment from 
volunteer peer counselors. (La Crosse 
Breastfeeding Task Force, La Crosse, Wis- 
consin) 

• Our program attempts to reach mothers in a 
broad socioeconomic base through one/one con- 
tact, and public media. ..meeting in small 
groups to discuss lactation management and 
mothering. In one part of the state, leaders have 
met with Reservation Indian mothers, and 
statewide, leaders are holding meetings at WIC 
distribution centers... finding times for meet- 
ings that fit with the group's particular needs 
...is so important, i.e., when she has time off 
from work, or in the case of Indian mothers, 
working around social customs. 

• Being sensitive to the needs and feelings of 
the mothers and their circumstances, es- 
pecially when they differ sharply from those of 
the LLL leader is essential. (Sensitivity) in- 
cludes choice of meeting places and Leader's 
dress when meeting with low-income groups. 
(La Leche League of Nebraska, Greeley, Ne- 
braska) 

LA MANERA CARINOSA/A LOVING WAY 

Culturally relevant materials was a need ex- 
pressed over and over again by survey respondents 
in all categories of programs. One local breastfeed- 
ing program responded to this need by developing 
"La Manera Carinosa/A Loving Way." This bilin- 
gual slide-tape presentation on breastfeeding was 
designed especially for the Hispanic culture of 
South Texas by the Travis Park Infant Nutrition 
Program in San Antonio, using a donation from a 
church. "The slide-tape is brief, simple, authentic, 
colloquial, and based on experience of the concerns 
and values of our clients," according to the pro- 
gram's description. The 8-minute presentation can 
be adapted to local settings with slide substitutes. 
It has been used by WIC clients and school pro- 
grams in Texas, Arizona, and Florida; cited as an 
exemplary educational tool by Health Education 
Associates; and used as part of a program winning 
the Pansy Ellen Essman Award from La Leche 
League International for work with teenage 
mothers. 



A PUBLIC EDUCATION CAMPAIGN: 
The Wisconsin Nutrition Project 

A private nonprofit organization, the Wisconsin 
Nutrition Project (WNP), has been conducting a 
public education campaign to promote breastfeed- 
ing among low-income women in two Wisconsin 
cities, Milwaukee and La Crosse. A survey of WIC 
sites in the State revealed that only 11 percent of 
WIC infants were totally breastfed and that 70 
percent were totally formula fed. Peer and family 
influence, physician's advice, and lack of nutri- 
tional awareness were the major reasons women 
chose formula feeding, according to the WIC 
Project Directors. Based on this information, the 
WNP designed a campaign with several com- 
ponents: 

• Community task forces were organized in each 
city, consisting of social service professionals and 
low-income women. 

• PSAs and posters were developed. 

• Two booklets were prepared: "A Mother's Hand- 
book: Combining Breastfeeding with Work or 
School" in English and Spanish, and "Starting a 
Telephone Support System for Breastfeeding 
Mothers." 

• Telephone support systems were established by 
the Task Forces. 

• Presentations were made to community groups 
and literature distributed at WIC sites and in cli- 
nics. 

• Educational meetings were held for pro- 
fessionals. 

The WNP's goal was to increase breastfeeding by 5 
percent in the two cities. Evaluation of the 2-year 
pilot project will be based on data from La Crosse 
and Milwaukee and from two control sites, Rock- 
ford, Illinois, and Stevens Point, Wisconsin. 

The La Crosse Breastfeeding Task Force reported 
the following results of its own program. "There 
has been a 6 percent increase in the incidence of 
breastfeeding among the La Crosse county WIC 
clients since the inception of the program. We have 
recruited and trained 25 peer counselors and 
matched 73 pregnant breastfeeding women with 
these counselors." 



DDD 



52 



NUTRITION PROGRAMS 



8 



Nutrition 
Programs 



The 279 nutrition professionals responding to the sur- 
vey described well-established programs on one hand, 
and complex personal and socioeconomic needs on the 
other. Programs that focus primarily on the nutrition- 
al needs of pregnant women and children are often 
part of large programs with broader goals and objec- 
tives. These programs receive funds and materials 
from Federal or State agencies, and these agencies 
conduct the needs assessments and evaluations. 

But within this structure and these resources, the 
local program coordinator must still grapple with a 
daily challenge. How can a program change what may 
be the most ingrained of personal habits — our diets? 
Supplemental foods combined with nutrition educa- 
tion are the primary tools of the Special Supplemental 
Food Program for Women, Infants, and Children 
(WIC), a Federal program. Peer counseling is the chief 
strategy of another Federal program found in many 
communities, the Expanded Food and Nutrition 
Education Program (EFNEP). Professional education 
and technical assistance are the functions carried out 
by State agencies. These three groups, WIC, EFNEP, 
and State nutrition programs, with the addition of 
some local projects, comprise this category of survey 
responses. 



WIC 

Responses from WIC programs far outnumbered all 
others in this category. WIC is operated by more than 
7,000 health clinics or other facilities in all parts of the 
United States. Funded by the Food and Nutrition Ser- 
vice of the U.S. Department of Agriculture, WIC 
serves low-income pregnant, postpartum, and 
breastfeeding women, and infants and children up to 
the age of 5 who have been determined to be at nutri- 
tional risk. WIC provides specific nutritious foods and 
nutrition education to program participants during 
periods of critical growth and development. WIC foods, 
which are high in protein, calcium, iron, and vitamins 
A and C, are designed to supplement program partici- 
pants' diets, but not to provide for total dietary needs. 



The foods provided include formula, cereal, eggs, milk 
and/or cheese, juice, and dry beans and peas or peanut 
butter. These foods are good sources of essential nutri- 
ents found to be lacking in the diets of program partici- 
pants. 

WIC participants are taught good eating habits 
through nutrition education in individual counseling 
or group sessions. Most local WIC agencies provide 
program participants with food vouchers to buy WIC- 
approved foods at retail stores. Some agencies distrib- 
ute foods directly or arrange for home delivery. 

Because the operation of the WIC Program is con- 
strained by a fixed amount of funds, as determined by 
Congress, all eligible persons cannot always be served. 
Therefore, those persons who stand to benefit most 
from WIC — pregnant women, especially pregnant 
teenagers and minority women — are targeted as the 
highest priority for outreach. 

How do local WIC programs reach the low-income 
women who need their services? WIC operates as an 
adjunct to good health care, and participants are re- 
ferred by WIC to additional health care services. Con- 
versely, private physicians, health care providers, and 
others are encouraged to refer their clients to WIC. 
Referrals from other local health services are one of 
the most common ways participants come to WIC. 
Numerous survey respondents in other categories 
mentioned referrals to WIC as one of their standard 
services. In fact, the WIC Program is so well es- 
tablished in many communities that references to the 
WIC Program turned up frequently in other survey 
replies. Many respondents said they had found 
coordination with WIC a good way to reach low- 
income women. 

But promotion and outreach are also important to 
motivate high-risk, potentially eligible clients to come 
to the WIC Program; as the Coalition's WIC reviewer 
pointed out: 

• We may need to reiterate to State and local 
agencies the importance of targeted outreach to 
direct the WIC Program to those in greatest 



53 



NUTRITION PROGRAMS 



need — pregnant women, particularly minority 
women, pregnant teenagers, and others at 
highest risk. 

Ideas from local WIC and other programs are de- 
scribed under "Other Services and Strategies" and 
"Outreach". 



EXPANDED FOOD AND NUTRITION 
EDUCATION PROGRAM (EFNEP) 

Providing low-income families with the skills and 
knowledge they need to plan nutritionally sound diets 
and incentives to change their dietary practices is the 
goal of the Expanded Food and Nutrition Education 
Program administered by the U.S. Department of 
Agriculture Extension Service in cooperation with 
State Cooperative Extension Services. The EFNEP 
Program currently operates in over 950 cities, coun- 
ties, and Indian reservations. 

The EFNEP approach is to train paraprofessionals 
and volunteers who usually live in the communities 
they serve. The aides teach low-income families why 
nutrition is important as well as a variety of practical 
skills related to nutrition — selecting and buying food, 
preparing meals, and managing food-related re- 
sources such as food stamps and gardens. Families in 
the program are recruited by the aides or referred by 
other community agencies. Several local EFNEP pro- 
grams responding to the survey reported developing 
special materials to reach their target populations; 
these are described in "Educational Materials." 

A typical EFNEP program was described by the Texas 
Agricultural Extension Service: 

• To improve the diets of limited income 
mothers, infants, and young children, the Ex- 
panded Food and Nutrition Education Pro- 
gram provides a minimum of six weekly les- 
sons on menu planning, food buying, and food 
preparation and safety. Lessons are taught by 
paraprofessionals instructed by professional 
nutrition educators... J n Hidalgo County, over 
a 4 -year period, 400 young couples completed a 
4-part short course which taught them pre- 
natal and infant nutrition.... Dietary recall and 
behavior checklists measure changes resulting 
from the program. In fiscal year 1984, 12 per- 
sons included in the September evaluation had 
made the following changes: 26 percent im- 
proved consumption of recommended servings 
of each food group, with 81 percent consuming 
their recommended servings after the program. 
Forty-eight percent were not consuming milk 
at the beginning of the program, but 57 percent 
drank two or more servings after the train- 
ing.... 



The EFNEP program of Oregon State University Ex- 
tension Service uses some innovative program deliv- 
ery techniques and exemplifies close cooperation be- 
tween WIC and EFNEP: 

• A cooperative program with WIC was de- 
signed to allow homemakers who are enrolled 
and actively participating in EFNEP to receive 
their WIC coupons by mail. This saves time 
and money for the homemakers who live a dis- 
tance from the WIC office. It saves aides time in 
recruiting homemakers. ...In a small town some 
60 miles from the office, two aides meet every 
other week with low -income homemakers who 
are recruited by WIC. Aides interview and en- 
roll these homemakers who are interested in 
EFNEP. ...Aide time is spent on group teaching 
and interviewing individuals and not on door 
knocking or other time-consuming recruiting 
procedures. Teaching packets that included all 
the EFNEP handout materials have been com- 
piled for each homemaker. There is a lesson 
checklist in each packet. ...Graduation cere- 
monies are held on a regular basis to honor the 
homemakers who are ready to move out of 
EFNEP. It is a recognition of each homemak- 
er 's achievement as well as the aide's progress. 
It encourages aides to move on to needy home- 
makers, rather than work with the same clients 
for several years. ...EFNEP provides materials 
and training to volunteers who teach in 
elementary schools, Head Start programs, 
community school programs, and park and 
recreation districts.... EFNEP has developed a 
symbiotic relationship with the Indochinese 
Cultural Center and Migrant-Indian Coalition 
in Portland. We present programs for their 
clients, they refer homemakers to us. We serve 
on their advisory councils and they serve on 
ours. 

The key to success for nutrition education, according 
to these local EFNEP respondents, lies in closeness to 
the community. "Get to know the neighborhoods in the 
program's target areas; involve members of the com- 
munity in the planning process," wrote the Massachu- 
setts EFNEP Program in Amherst. "The program 
tends to work best where these things have been done, 
where staff is committed to the families in the neigh- 
borhood, and where specific teaching materials are 
available and followed." 



OTHER SERVICES AND STRATEGIES 

Although often affiliated with larger programs, local 
nutrition programs must face local problems. Like 
other programs, they constantly seek ways to reach 
low-income women in their own areas and make their 



54 



NUTRITION PROGRAMS 



JUICY — JUGOSOS 





HUNGRY — 



HAMBRIENTOS 



Texas Department of Health 



services appealing. Some of the techniques brought to 
light by the survey: 

Advertising at local stores. Putting promotional 
materials in laundromats and grocery stores draws 
clients, according to the Crawford City WIC Program, 
Bucyrus, Ohio. 

Babysitters. Providing a babysitter allows mothers 
to focus their full attention on classes, advises the WIC 
Program in Chatanooga, Tennessee. Using Red Cross 
volunteers as babysitters at the clinic was suggested 
by the Winman County, Winona, Minnesota, Red 
Cross Chapter. 

Bill stuffers. The Amarillo Bi-City-County Health 
Department in Amarillo, Texas, sends WIC advertise- 
ments with the city water bills. 

Bilingual staff. The WIC respondent at the South 
End Community Health Center in Boston reported 
"We have all bilingual staff (English and: Cantonese, 
Mandarin, Vietnamese, Cambodian, Spanish, 
French)." 

Nutritional charting. The Detroit Maternity and In- 
fant Care Project reported that "individual counseling 
and assessing nutrient intake using the 24-hour in- 
take are tools used for introducing nutritional needs 
during pregnancy." Another tool, called "Food Fre- 
quency," is used to show improvements in nutrient 
intake. 

Group discussions. The same program added that 
"there has been a decrease in the incidence of low 
hemoglobin (90%/dl) due to group discussions on the 
importance of iron during pregnancy for mother and 
baby. "Team work," it added, "has been very impor- 
tant in this respect. Doctors and nurses have been 
cooperative during the discussions on total nutrition 
and the formation of hemoglobin in the body." One 
other comment from this respondent: "Certifying 
clients for WIC has provided excellent motivation for 
changes in eating habits." 



STAFFING 

In addition to trained aides and volunteers in WIC and 
EFNEP (described earlier), State programs also rely 
on other volunteers. 

One county health department described an approach 
using volunteer paraprofessionals as nutrition educa- 
tors: 

• The Palm Beach County Paraprofessional 
Education Program in West Palm Beach, Flor- 
ida, involves senior aides (retired persons) and 
other volunteers, and one staff person. The pa- 
raprofessional volunteers counsel patients in- 
dividually in the clinic waiting room before 
appointments and give them nutrition hand- 
outs. They also inform patients of other ser- 
vices, such as WIC, food stamps, and 
breastfeeding classes (La Leche League Inter- 
national). A nutrition education topic is fea- 
tured each month in the counseling and hand- 
outs as well as on a waiting room bulletin 
board. A dietitian conducts monthly inservice 
training sessions for the volunteers. 



OUTREACH 

Campaigns to reach needy families were reported by 
three WIC Program respondents: 

• The WIC 10th Anniversary Public Aware- 
ness Campaign in Tennessee was designed "to 
better inform the public of services offered and 
program benefits." Not only was there an effort 
to reach eligible persons directly (media, 
brochures, posters), but also to contact pro- 
fessionals, e.g., physicians, who would be refer- 
ral sources. This campaign was a part of a 
4 -year Tennessee Governor's Healthy Child 
Initiative. As a result of this campaign, "the 
number of prenatal and infant WIC partici- 
pants increased. In addition, TV stations 
across the State are still using the PSAs." 

• The Texas Department of Health has four 
PSAs to publicize WIC. They can be used on 
either radio or television, are contained on one 
reel-to-reel tape, and come with three slides 
and an instruction packet. 

• The Florida WIC Program reported a 
statewide media campaign to inform WIC par- 
ticipants and the general public about proper 
nutrition. Three video PSAs were made and 
sent to every TV station in Florida. These are: 

"Bad Habit Rabbit and the Eatwell Kids," a 
PSA developed for preschool children. The 
muppet-like characters are situated in a picnic 
setting. The Eatwell Kids teach Bad Habit 



55 



NUTRITION PROGRAMS 



Rabbit the importance of eating a variety of 
foods. Sweets and snack foods are presented as 
part of a total diet. 

"I'm In the Mood For Healthy Food," which 
presents a teenage girl who has a nightmare in 
which she is assaulted by several larger-than- 
life fad diet products. After fighting off her 
attackers, she awakens in control. This spot is 
directed toward young adults, particularly 
young postpartum women. 

"Get Up and Go" involves Nutri-girl, an over- 
weight superheroine who has difficulty achiev- 
ing her full potential because of extra baggage 
that is symbolic of obesity. After casting away 
her excess baggage slowly, one piece at a time, 
Nutri-girl changes into her superheroine cos- 
tume and flies away into the night. 



EDUCATIONAL PROGRAMS 

State nutrition initiatives. Many States, through 
their departments of health, sponsor nutrition pro- 
grams that relate to pregnancy and infant care for 
low-income families. Most typical of those that re- 
sponded to the survey were programs that assist 
health professionals who provide services. Nebraska, 
for instance, provides technical assistance to local 
health and community agencies, and it has developed 
resource materials for nutrition education and 
counseling in prenatal and parenting education 
classes. 

Missouri, another good example, has established 
maternal and child health objectives based on the 
Federal health promotion objectives for 1990 and is 
working toward its goals through a number of pro- 
grams for health professionals. Among its nutrition 
activities: 




The Cooperative Extension Ser 




• A perinatal nutrition network and newslet- 
ter, providing up-to-date information to over 
350 professional nutritionists, dietitians, and 
nurses working in prenatal and infant care; 

• A hospital network for perinatal nutrition 
clinical problems to provide state-of-the-art in- 
formation and clinical experience in caring for 
hospitalized patients with specific problems; 

• Inservice training on the nutritional man- 
agement of the high-risk pregnant woman; 

• Development of programs for the nutritional 
management of diabetics and adolescents who 
are pregnant. 




The Cooperative Extension Service, University of Georgia 



University of Georgia 



Virginia's Division of Public Health Nutrition has 
developed a booklet for health professionals on nutri- 
tion in pregnancy "because of outdated nutrition prac- 
tices such as weight and salt restrictions still utilized 
by some medical personnel." Virginia, however, found 
that working through health professionals was not 
always enough. In the mountainous southwest corner 
of the State, the roads are poor and communication 
difficult; there are three counties that have no ob- 
stetricians. To reach the pregnant women in this area, 
the State developed five public service an- 
nouncements for television. The 30-second messages 
address prenatal nutrition, breastfeeding, and infant 
nutrition. 

Local nutrition programs. Staff from nutrition pro- 
grams on the local level, not affiliated with WIC or 
EFNEP, responded to the survey. Most were county 
health departments, with special nutrition education 
components; others were local chapters of national 
organizations — the Red Cross, The Salvation Army, 
and Catholic Charities. Services ranged from the Red 
Cross nutrition course, "Better Eating for Better 
Health," described by the District of Columbia Chap- 
ter (see American Red Cross/DC Chapter in program 
listing), to a supplemental food program sponsored by 
Catholic Charities (see Mother and Child Nutrition 
Program, Chicago, Illinois). Social Services, a Salva- 
tion Army program in Kansas City, Kansas, helps 
low-income families prepare monthly menus and 
shopping lists to make food stamps last the whole 
month. 



56 



NUTRITION PROGRAMS 



EDUCATIONAL MATERIALS 

Nutrition programs, according to many of the survey 
replies, provide a wide range of education materials 
(although there remains a need for easy-to-read mate- 
rials). Lists of materials used were often long, and the 
sources were nationally known organizations. Fre- 
quently cited were the Dairy Council, the U.S. Public 
Health Service, the U.S. Department of Agriculture, 
Cornell University, Proctor and Gamble, Gerber Prod- 
ucts, Ross Laboratories, and Mead-Johnson. State 
health departments have developed nutrition materi- 
als, too, and these are used by many respondents. 
Some programs have developed their own materials of 
adapted those from other sources for use with their 
specific target audiences. 

Like State health departments, many WIC programs 
have developed their own materials, ranging from 
one-page flyers to slide-tape presentations. The Coali- 
tion's WIC reviewer observed that: 

• There appear to be informal networks that 
many States and local agencies have es- 
tablished to reprint and adapt materials from 
other States. On the other hand, the needs that 
were stated on the survey forms were mostly in 
the areas of program and nutrition education 
materials, which suggests that more formal 
networks may need to be established. 

Materials for specific ethnic/cultural groups. A 

number of programs have developed materials for par- 
ticular ethnic groups. The WIC Program of the Cher- 
okee Nation of Oklahoma in Tahlequah, for example, 
has prepared both WIC program and nutrition educa- 
tion materials for Native Americans. (This program 
has also developed a paraprofessional education cur- 
riculum to train employees of Oklahoma WIC State 
agencies.) The WIC Program in Oklahoma City has 
translated materials into various and unusual lan- 
guages — Spanish, Cambodian, Vietnamese, Hmong, 
Laotian, Thai, and Romanian. In New Rochelle, New 
York, the local program has developed Spanish and 
Creole materials. Other programs' materials include 
Spanish prenatal materials developed by the WIC pro- 
gram in Middletown, New York; and Spanish 
breastfeeding materials and other maternal and child 
health materials, by the WIC Program in Rhode Is- 
land. 

Lessons and curricula. The EFNEP of Ohio State 
University Cooperative Extension Service in Colum- 
bus has developed an 8-month maternal nutrition 
calendar with 24 companion lessons. The Texas WIC 
Program described 37 module lessons on prenatal and 
postpartum nutrition containing narrative, pre- and 
post-tests, and usually a short audiovisual. 

The EFNEP of Cornell University's Cooperative Ex- 
tension Service in Ithaca, New York, described a vari- 
ety of nutrition materials produced by the University. 



FEEDING YOUR LITTLE ONE 



Why Doesn't Your Child Eat? 




The Cooperative Extension Service, University of Georgia 



These include slide sets on "Nutrition During Preg- 
nancy" and "Feeding Your Baby," flip charts (11" x 
17") with the same titles, and a notebook of 12 lesson 
plans and handouts for teaching nutrition. Of the les- 
son plans, this program wrote: 

• The colorful artwork and straightforward 
language make these materials easily under- 
standable for teenage and adult audiences. The 
lessons will be enjoyed by those with limited- 
to-average reading ability. The multi-racial 
and ethnic character of these materials make 
them appropriate for a wide variety of au- 
diences. 

A supplementary section for WIC programs contains 
12 display or demonstration ideas, a lesson that re- 
lates to the WIC program and WIC food package, and 
dietary evaluation forms. 

A curriculum on nutrition for older infants and an 
infant feeding guide have been developed by the Com- 
bined Health District, Montgomery County - WIC, in 
Dayton, Ohio. 

A flipchart, "Food for You," was designed for use in 
small group and individual nutrition education ses- 
sions by the Florida WIC Program in Tallahassee. One 
of each of the five food groups is depicted on a page, 
with ethnic as well as typical foods representing the 
food group. The foods are identified in English, Span- 
ish, and French. A corresponding pamphlet for clients 
to take home is also distributed. 



57 



NUTRITION PROGRAMS 



Easy-to-read materials. The Columbus, Georgia 
EFNEP has developed three brief, large-print, illus- 
trated leaflets on infant and child nutrition. Subjects 
include snacks, poor appetites, overeating, feeding 
children, and making meals a pleasant time. It also 
produced two instruction sheets for preparing infant 
formulas that use pictures and a minimum of words. 

To teach child nutrition, coloring books have been 
developed by the Woodbury County Community Ac- 
tion Agency, WIC/Well Child program in Sioux City, 
Iowa. 

Newsletters. Oklahoma University Cooperative Ex- 
tension Service has developed a 3-month series of six 
newletters called the "Next Nine Months" to provide 
pregnant women with updated nutrition information 
for optimum prenatal care. According to the booklet 
describing the series: 

• The newsletters can be used for scheduled 
lessons for the new mother or can be distributed 
by mail. Should you wish to develop an exten- 
sive program with the Health Department, a 
nurse, March of Dimes, La Leche League, etc., 
there is a list of additional resources you can 
use.... There are two news releases and one 
radio spot that you can use to advertise the 
"Next Nine Months" series. One way of promot- 
ing the program is by using the promotional 
brochures. These can be placed in the physi- 
cian's office for further visibility by the preg- 
nant mother. 

Pamphlets. The WIC Program in Waterloo, Iowa, has 
produced one-page flyers on weight loss for children 
("Help Your Child Grow Slim"), infant feeding sched- 
ules, and a third entitled "Protein Partners." 

Other materials include: "Plan a Garden for Nutri- 
tion," a pamphlet developed by the WIC Program of 
the Cherokee Nation in Tahlequah, Oklahoma, and a 
pamphlet on breastfeeding by the WIC Program in 
Joplin, Missouri. 

Slide-tape programs. The Texas WIC Program has 
developed seven bilingual slide-tape programs in Eng- 
lish and Spanish specifically designed for the WIC 
participants in the State. One of these pubicizes the 
WIC program and the others demonstrate various 
facts about good nutrition. 



NEEDS FOR EDUCATIONAL MATERIALS 

Just as the survey respondents did in every previous 
category, nutrition program respondents expressed 
needs for more free materials and for materials appro- 
priate for low-reading levels (more pictures) and 
specific ethnic groups, such as Native Americans. 
Printed materials that teach through pictures were 
suggested by several respondents. The topics noted 



SNACKS 




Texas Department of Health 



ANTOJITOS 



under needs were numerous and wide ranging, with 
no real consensus evident; breastfeeding, adolescent 
pregnancy, and obesity in infants and children were 
cited most often. Also mentioned: baby bottle tooth 
decay, smoking, drugs, lactose intolerance and cal- 
cium for pregnant women, myths concerning diet in 
pregnancy, infant development and infant nutritional 
needs, plant protein food sources, exercise and preg- 
nancy, child safety, and recipes for low-income fami- 
lies. Audiovisual materials — films and slide tapes — 
on a variety of topics were also suggested, as well as 
PSAs to promote available services. 



ADVICE AND OBSERVATIONS 

Eating habits do not change quickly. "Progress is 
slow," commented a nutritionist from the Mother- 
Child-Health-Nutrition Direct Counseling Program 
in Harrodsburg, Kentucky. "It takes months, years, to 
see results in a family setting." These survey respon- 
dents recommended patience and attention to the de- 
tails of program planning. 

• The time spent in needs assessment research 
....is crucial for the construction of an appropri- 
ate educational program. In a rush to evaluate 
impact, we often neglect the monitoring of pro- 
gram processes. This monitoring is crucial in 
large-scale projects which in all likelihood will 
not change behavior in the short term, advised 
the EFNEP Breastfeeding Education Pro- 
gram.(Basics of Breastfeeding, Ithaca, New 
York) 

And concerning evaluation and personnel, "have sur- 
veillance in place before starting a program. Have 



58 



NUTRITION PROGRAMS 



good field people to work with the public," wrote the 
Southeast Region Nutrition Services in Chattanooga, 
Tennessee. As in other areas, respondents cited the 
need to coordinate all community agencies' resources. 
"The coalition approach works best," said the Com- 
modity Supplemental Food Program in New Orleans. 

Other observations offered by respondents included: 

• Participants do not consider printed material 
as an information source. Interaction between 
teacher and students is most effective. (WIC 
Program, Lawrenceburg, Indiana) 

• Active participation of students relating in- 
formation to their personal experience is effec- 
tive. (WIC Program, Adrian, Michigan) 

• Printed testimonials from mothers who have 
participated in a program could provide 
encouragement to others. (WIC Program, Sauk 
Rapids, Minnesota) 

• Group education is most effective when cover- 
ing education material, but time set aside for 
individual contacts is very valuable for dis- 
cussing problems and referring to other agen- 
cies. Also some clients are very shy in group 
settings and will not ask questions. (PPAMV — 
WIC Program, Utica, New York) 

• Work with other agencies. Joint development 
increases quality and usage. It's important that 
we all give the same message to mothers. 
(EFNEP — University of Hawaii Cooperative 
Extension, Honolulu, Hawaii) 

• Regular Extension programming for ex- 
pectant parents has been successful when pro- 
grams were planned by local groups including 
representatives from related medical groups 
and agencies. (Texas Agricultural Extension 
Service, College Station, Texas) 

• The entire family should be provided in- 
formation — not just the mother and child. 
(WIC Program, Pleasanton, Texas) 

• Any poster or printed material should have a 
lot of pictures. The reading level should be 6th 
grade or below. Pamphlets should be one page 
long. The Healthy Mothers, Healthy Babies 
cards are wonderful. (WIC Program — South 
End CHC, Boston, Massachusetts) 

• Survey needs and interests of clients. Make it 
fun! (Columbus, Ohio, Department of Health) 

• Group discussions are as important as in- 
dividual counseling. It is a good method to 
communicate with all clients. Depend on your 
medical and professional team, to help motivate 
your client. Be sure to include your social work - 
er. (Detroit Memorial Hospital, Detroit, 
Michigan) 



The Cooperative Extension Service, 
University of Georgia 




BABY DAY AT A WIC CLINIC 

To celebrate the 10th anniversary of the WIC Pro- 
gram, the Jefferson Comprehensive Health Center, 
Nutritional/WIC Services, in Fayette, Mississippi, 
sponsored a special "Baby Day." Mothers with in- 
fants under 7 months old were invited to the Center 
for fun, food, infant exams, and nutrition education. 

Here are some excerpts from this program's booklet 
describing Baby Day: 

• Upon entering the Center, a colorful standing 
clown clutched a sign with the caption, "Hi 
Kids" to greet the participants. Mounted on the 
front entrance wall was a colorful blue umbrel- 
la on which large letters cut in pink spelled out 
"Welcome to Baby Day." A long table covered 
with blue was placed in front of the welcome 
scene. The table held a wide assortment of edu- 
cational materials, and. ..gift packs... As the 
participants waited in the attractively de- 
corated hall, demonstrations and film viewing 
were conducted at various intervals through- 
out the day.... While engaged in these sessions, 
the parent along with the infant would be sing- 
ly called into the nutrition department. In the 
inner office, the infant's anthrometric 
measurements were taken and a growth chart 
plotted and evaluated and counseling was pro- 
vided.... Parents at this time were issued a 
number to be used later for the drawing of a 
prize. ...Once the infant's parent had taken part 
in all of the activities, she was guided to the 
main patient waiting room. While waiting to be 
called by the nurse, the parent had the pleasure 
of viewing a few short video tapes. (Projector 
and tapes were both complimentary from Ross 
Laboratories.) Throughout the day, special 
prizes were awarded.... To capture the day long 
activities, pictures were taken throughout the 
day by two volunteer staff employees and the 
local newspaper.... The resultant publicity en- 
couraged other needy mothers in the area to 
come and enroll in the WIC Program. 



59 



SUBSTANCE USE DURING PREGNANCY 



9 



Substance Use 
During Pregnancy 



The majority of the 45 programs responding to the 
survey that specifically address substance abuse dur- 
ing pregnancy focus on education and prevention. 
They seek, through a variety of methods, to raise 
awareness of the devastating effects of alcohol and 
tobacco on the unborn child, and are targeted to the 
general public and health professionals, as well as to 
pregnant women. This chapter is organized to reflect 
the two categories of program responses; alcohol and 
pregnancy and smoking and pregnancy. Little men- 
tion was made of drug abuse in survey responses. 

ALCOHOL AND PREGNANCY 

Respondents working in alcohol education programs 
describe their programs as broad-based often featur- 
ing educational programs for elementary and secon- 
dary school students as well as community groups. A 
few are actively involved in identifying, referring or 
treating, and following up with the alcohol-abusing 
pregnant woman, but these treatment components 
tend to be the exception rather than the rule. For the 
most part, the programs focus on awareness-building 
through a variety of activities. 

The broad-based programs generally rely on State 
funding. In fact, for a number of them, overall 
coordination is provided at the State level, such as 
Georgia's Fetal Alcohol Syndrome Task Force, op- 
erated by the Georgia Department of Human Re- 
sources. Responsibility for Ohio's "Thanks, Mom for 
Not Drinking Alcohol During Pregnancy" public in- 
formation campaign is shared by the State Bureau of 
Maternal and Child Health and the Bureau on Alcohol 
Abuse and Alcoholism Recovery. In some cases, State 
funding is provided to a local organization that op- 
erates a major, even statewide effort. Examples are 
Nebraska's Fetal Alcohol Syndrome Prevention Pro- 
gram run by the Lincoln Council on Alcoholism and 
Drugs, Inc., and the New River Mental Health Center 
in Boone, North Carolina, which operates a five- 
county prevention program with State funds. Large 
programs that offer an array of services and attempt to 
reach many people through a variety of outreach 
efforts must rely to a great extent on public funds for 



their operation. These programs frequently receive 
additional support from service organizations, such as 
United Way or March of Dimes. 

Many print and audiovisual materials on fetal alcohol 
syndrome (FAS) and fetal alcohol effects (FAE) have 
been created at national (i.e., National Institute of 
Alcoholism and Alcohol Abuse) and State levels, and 
by voluntary organizations such as the March 
of Dimes. While some programs use already-existing 
materials, most also create their own more in- 
dividualized publications to incorporate a campaign 
theme or logo, or to serve a special population. The 
Alaska Council on Prevention of Alcohol and Drug 
Abuse, for example, has created prevention-focused 
materials in native Alaskan dialects. Because many 
programs seek to educate lay persons — including 
adolescents — about alcohol-related birth defects 
through curricula and presentations, films aimed at 
general audiences play an important role. However, 
the need for materials aimed at specific audiences was 
cited by a number of program respondents. Without 
exception, materials included with survey responses 
emphasized that pregnant women should abstain from 
drinking during pregnancy. As stated earlier, few pro- 
grams were specifically targeted at detection and re- 
ferral of alcohol-abusing pregnant women, though 
many seek to inculcate health professionals with the 
skills to do so. Samples of program activities appear 
below: 

Public education efforts. Schools, churches, and 
community groups are the targets of educational out- 
reach efforts described by survey respondents. For ex- 
ample: 

• The Florence County Commission of Alcohol 
and Drug Abuse in Florence, South Carolina, 
distributes alcohol materials at health fairs, 
including a college alcohol fair, and makes 
presentations to church groups. 

• The Fetal Alcohol Syndrome Prevention 
Effort in Indianapolis, Indiana, plans a public 
awareness campaign using Public Service An- 
nouncements (PSAs) and various print materi- 
als. Counseling and support groups through 



60 



SUBSTANCE USE DURING PREGNANCY 



Planned Parenthood prenatal clinics are 
planned, also. 

• The New River Mental Health Center in 
Boone, North Carolina, provides programs, 
films, and printed materials for 9th-grade stu- 
dents. It also distributes information at pre- 
natal clinics. 

• The Cobb-Douglas Mental Health Center in 
Austell, Georgia, makes presentations on FAS 
and FAE to community agencies, organiza- 
tions, and service groups and distributes liter- 
ature to such groups. 

• The Alcoholism Council in Cos Cob, Con- 
necticut, gives a class on FAS for 10th, 11th, 
and 12th graders as part of an alcohol educa- 
tion program in the schools. 

Professional education efforts. Other alcohol 
awareness programs focus their efforts on health pro- 
fessionals: 

• The Tidewater Council on Alcoholism in 
Norfolk, Virginia, makes presentations to 
nursing schools on FAS, alcoholism, and 
malnutrition. 

• To reach local physicians and nurses, the 
New River Medical Health Center in Boone, 
North Carolina, has organized a seminar 
through The Bowman Gray School of Medicine 
on "Alcohol: Effects on the Fetus." 

• The Green County Alcohol Information and 
Referral Center in Catskill, New York gives 
workshops for teachers and public agencies. 

Intervention efforts. One survey respondent de- 
scribed a comprehensive statewide program that in- 
cludes both education and intervention components. 

• The Lincoln Council on Alcoholism and 
Drugs, Inc., a nonprofit local affiliate of the 
National Council on Alcoholism, has operated 
the FAS Prevention Program since October, 
1984, in a 16-county area in Southeast Ne- 
braska. Funding for the program has been pro- 
vided by the Governor's Planning Council on 
Developmental Disabilities, located within the 
Nebraska State Department of Health. The 
overall program is coordinated by an advisory 
board comprised of representatives from local 
and State-level human services. 

According to the Program Coordinator, "the 
ultimate aims of the program are to reduce the 
number of new cases of Fetal Alcohol Syn- 
drome (FAS)IFetal Alcohol Effects (FAE), as 
well as to assist those children and families 
already affected, and to create an awareness 
and acceptance that consumption of alcohol 
during pregnancy can have deleterious effects 
on the fetus." 



The program incorporates a comprehensive 
approach, which includes the following com- 
ponents: 

Primary Prevention Activities targeting low- 
and moderate-risk women, and consisting of 
teacher training, public information efforts 
(television and radio PSAs and programs, 
press releases, and the development of 
brochures, fact sheets, and newsletters) , and 
professional education. Professional education 
efforts include community level workshops, 
perinatal Grand Rounds with keynote physi- 
cians, packets "of information for physicians, 
and consultation with nursing schools on cur- 
riculum revision. 

Secondary Prevention Components consist of 
professional training and consultation to 
health and other human services workers. 
Training focuses on identification of high-risk 
(alcohol/drug abusing) women of childbearing 
ages, and counseling techniques. TheFAS Pre- 
vention Program has developed a screening 
questionnaire for use in training and health 
care settings. The form is also used to facilitate 
the project's data collection efforts on alcohol 
use patterns by pregnant women. 

Tertiary Prevention Efforts focus on high-risk 
populations, and consist of providing referral 
information and guidance to alcohol-abusing 
women and affected children. Directories of lo- 
cal resources serving alcohol -abusing women 
and those providing diagnostic evaluations to 
affected children have been developed. Plans 
are underway to develop support groups for 
women with FASIFAE children. 

The program has routinely conducted several 
ongoing evaluation activities since its incep- 
tion. These include assessment of training ses- 
sions for health and other professionals; collec- 
tion of data concerning the public's knowledge 
about the effects of alcohol use during pre- 
gnancy; and administration of a pre- and post- 
test survey to pregnant women concerning alco- 
hol's effects on the fetus. 



SMOKING AND PREGNANCY 

Smoking programs, like alcohol programs, empha- 
sized prevention and education, rather than active 
intervention programs. Most survey responses in this 
category came from local chapters of the American 
Lung Association (ALA). These chapters distribute 
their Smoking and Pregnancy Kit for health care pro- 
viders. Developed by the national ALA office, the pro- 
fessionals kit includes a take-home kit for pregnant 
women. Several local health agencies also described 



61 



SUBSTANCE USE DURING PREGNANCY 



smoking education programs involving patient 
counseling and educational literature. Funded pri- 
marily by State and local governments and, in the case 
of the ALA chapters, their own organization's budget 
supplemented by donations from local businesses, 
these programs are centered in health care facilities — 
such as doctor's offices and clinics — and are aimed at 
pregnant women in general, including, but not limited 
to, those with low incomes. 

Smoking education materials. Patient counseling 
materials and handouts for the pregnant woman are 
the most common elements of the programs — ALA 
and others — responding to the survey. The ALA 
materials consist of a kit for health care providers 
containing a handbook on counseling, a flip-chart, a 
tent card, posters, and an article. A smaller packet of 
information for the patient (available in English and 
Spanish) is included and consists of two pamphlets: 
one focuses on the dangers of smoking to the fetus; and 
the other addresses typical rationalizations smokers 
present to health care providers. Other programs men- 
tioned using materials from the American Cancer So- 
ciety ,the American Heart Association, and the March 
of Dimes. 

Outreach. Using and in some cases adapting these 
materials, several survey respondents reported 
special outreach efforts directed to low-income 
women. 

• The District of Columbia Lung Association 
(see Smoking and Pregnancy, Washington, 
D.C., inprogram listing) adapted ALA materi- 
als to develop its own question-and-answer 
brochure, "Special Information for the D.C. 
Mother to Be." This program also coordinated 
"a demonstration project for pregnant black 
women of low SES at selected prenatal counsel- 
ing centers in order to develop an effective and 
replicable antismoking intervention for this 
audience." It also held smoking education pro- 
grams for pregnant teenagers. 

• The South Dakota Lung Association (Smok- 
ing and Pregnancy, Sioux Falls, South Dako- 
ta) adapted one of the standard ALA posters, 
reproducing it with an Indian mother and baby 
to appeal to the Native Americans in the State. 

• The Wisconsin Lung Association (Breathing 
for Two, Milwaukee, Wisconsin) adapted ALA 
"Smoking and Pregnancy" materials for a high 
school audience. The same program obtained 
Federal block grant monies for extensive dis- 
tribution of ALA materials to city and county 
health departments, WIC sites, social service 
agencies, and primary care centers. 

• The American Lung Association of Sac- 
ramento (Smoking and Pregnancy, Sac- 
ramento, California) has worked with teen cli- 
nics, schools, and hospitals. It is seeking funds 



to implement a program at the local county 
hospital. 

• The Inter-Agency Anti-Smoking Program 
with Pregnant Women in Los Angeles has 
trained WIC staff to conduct antismoking ses- 
sions with the goal of decreasing both prenatal 
and postpartum smoking among low-income 
women. 

Smoking cessation. Two programs reported con- 
certed smoking cessation efforts involving several 
intervention strategies. 

• The Smoking Cessation Program for Pre- 
natals in Anderson, South Carolina, described 
a multifaceted effort to get its pregnant patients 
to quit. "Statistics show that 42 percent of our 
Oconee Health Department patients smoked 11 
or more cigarettes daily. With that fact in mind, 
an inservice for nursing staff was given... "All 
new patients now attend a substance abuse ses- 
sion where alcohol, cigarettes, and drugs are 
discussed. The excellent 10-minute film, "It's 
Up to Me," which the March of Dimes produced, 
is used to initiate the class. Patients are then 
interviewed by the nurse using the Patient 
Flowchart and Smoking Record which staff 
developed in conjunction with the Lung 
Association. If patients are interested in quit- 
ting, the (ALA) Kit for Pregnant Women is 
shared. Smokers are then classified by a check- 
list as to smoking type such as habit, tension 
reduction, etc. Depending on what type of 
smoker they are found to be, an objective for the 
period between visits is agreed upon... and writ- 
ten on the Patient Flowsheet Form. On subse- 
quent visits, progress is recorded again on the 
form. When smokers quit, they are rewarded 
with a baby's shirt printed by local merchants 
which reads,"My Mom Quit Smoking Because 
She Loves Me." 

• The Detroit Health Department's Health 
Education Risk Reduction (HERR) Program 
primarily aims to reduce smoking among 
minority female adolescents and young adults. 
Targeted at clients in the Health Department's 
family planning, prenatal and postnatal, and 
gynecological clinics, intervention strategies 
include peer pressure resistance, coping mech- 
anisms, and stress reduction. Clients who do 
not smoke are assigned to programs which 
reinforce positive healthy behaviors. Between 
1980 and 1984, 583 smokers entered the pro- 
gram. Of these, 109 or 18.6 percent stopped 
smoking. Among nonsmokers and nondrink- 
ers, the program was 100 percent successful in 
preventing onset of smoking and drinking. 
More evidence of success: the fetal death ratio of 
HERR clients was 4.8 per 1,000 live births 
versus 9.0 per 1,000 for the city of Detroit in 
general. 



62 



SUBSTANCE USE DURING PREGNANCY 



OUTPATIENT TREATMENT 
FOR SUBSTANCE ABUSE 

The Hutzel Hospital Substance Abuse Program for 
Women in Detroit is designed to treat women who 
have problems with all substances, including illegal 
drugs. One of only six such programs in the country, it 
treats women in the Detroit area but provides in- 
formation to people throughout the United States. The 
following description was included with the program's 
survey response: 

• Pregnancy and addiction are verified and 
fully documented, establishing the initial goals 
of treatment.... Besides direct counseling ser- 
vices, the social workers intercede on patient's 
behalf with landlords, probation officers, the 
judicial system.... Educational groups are 
available for the new patient, and, in effect, are 
a required part of program expectations. In the 
last trimester of pregnancy, one of the nurses 
provides birth preparation on an individual 
basis or, if several women are involved, a group 
is provided. ...When a patient's baby is born.... a 
12 -week, group modality deals with parenting, 
the emotional component of substance abuse, 
and relationship issues. 

NEEDS FOR EDUCATIONAL MATERIALS 

Materials and programs for specific audiences, includ- 
ing (the support role of) the partner, were the needs 
most frequently cited by these survey respondents. 
Translated materials and materials, especially au- 
diovisuals, for low reading levels; materials aimed at 
pregnant adolescents; and materials for minorities 
were mentioned. Programs with appropriate learning 
experiences and meaningful incentives for non-urban 
audiences are also needed, according to these respon- 
dents, as well as educational materials of all kinds 
addressing drug use and pregnancy. 

ADVICE AND OBSERVATIONS 

Most of the good advice from respondents to those 
interested in starting up similar programs can be 
summarized in a quote from one provider, "Education 
is the key to success." Education often focuses on two 
separate populations — professionals and the general 
public. Advice on educating professional groups in- 
cludes the following: 

• Be sure to go further than simply encourag- 
ing professionals to educate women about FAS/ 
FAE. They need to know how to refer and fol- 
low up on pregnant women who they suspect 
are abusing alcohol, as otherwise these women 
are not likely to get to treatment. Therefore, it is 
important to conduct professional education 
programs first. (Ohio Department of Health, 
Bureau of Alcohol Abuse and Alcoholism 
Recovery, Columbus, Ohio) 

• Pregnant women are very interested in fetal 
development and, therefore, motivated to learn 
and change behavior. It is important that clinic 



staff reinforce the written information given to 
patients with verbal messages. (Health 
Education/ Health Promotion Project, Cincin- 
nati, Ohio) 

• When developing program components, try to 
narrow the focus to specific target groups or 
women. Also, any FAS education and preven- 
tion effort should include information on 
women's use of alcohol. (Lincoln Council on 
Alcoholism and Drugs, Inc., Lincoln, Ne- 
braska) 

• Before implementing any program develop 
an evaluation method. ...Budget funds or solicit 
funding to provide free materials to in- 
dividuals and facilities; obtain massive media 
support to aid in promotion. (Smoking and 
Pregnancy Program, Charleston, West Vir- 
ginia) 

Two other complementary suggestions from respon- 
dents concerned organizational considerations. One 
respondent recommended that efforts harness and 
coordinate both the variety of State and local efforts 
that exist (taking into account all of the alcohol/drug, 
maternal/child health, and developmental disabilities 
resources, where possible). Another advised that any 
multicomponent FAS effort requires a pivotal, central 
office specially funded for this purpose, which can take 
responsibility for overall coordination, materials dis- 
semination, and technical assistance. 

Suggestions for public education programs included: 

• Provide information at community health 
fairs and at college-level alcohol awareness ac- 
tivities. (Florence County Commission on Alco- 
hol and Drug Abuse, Florence, South Caro- 
lina) 

• Take into account the fact that, for low- 
income women, "Smoking may be one of the few 
pleasures they can obtain on a daily basis." 
(Smoking and Pregnancy, Richmond, Vir- 
ginia) 

• "Networking with health professionals hav- 
ing 'hands-on' experience with the various pop- 
ulations in the prenatal counseling programs 
is the key to successful endeavors, together with 
feedback from the individuals being counseled 
on presentations and materials used and sug- 
gestions for improvements." (Smoking and 
Pregnancy, Washington, D.C.) 

• "Through educational programs, PSAs, 
newspaper articles, and films the community's 
awareness of FAS prevention is working, be- 
cause over the years we keep repeating the mes- 
sage." (New River Mental Health Center, 
Boone, North Carolina) 

• Contact local ALA offices to determine in- 
formation specific to a certain region such as 
estimates of the number of pregnant smokers. 
(Smoking and Pregnancy, Richmond, Vir- 
ginia) 



63 



RURAL POPULATIONS 



10 

Rural 
Populations 



In rural areas of the country, places as diverse as 
Appalachia and southern California, northern Michi- 
gan and the Southwest, health care providers face 
similar problems. Usually based in primary care cli- 
nics, these 36 survey respondents — physicians, physi- 
cian assistants, nurse practitioners, and health educa- 
tors — share the problems posed by a shortage of 
medical personnel, a clientele spread over several 
counties, and poor transportation. "Our nearly 9,000 
population is scattered. We have no hospital in the 
county, one MD and 2 DOs (near retirement) and one 
DO in his 30s," wrote the Daviess County Health De- 
partment in Gallatin, Missouri. Above all, according 
to those that responded to the survey, these programs 
face problems of communication with their patients 
because of language or cultural barriers. 

The shortage of health personnel is the raison d'etre 
for many of these programs. Established in medically 
underserved areas, they often received Federal fund- 
ing channelled through the community health or mi- 
grant health programs. They offer primary health 
care, including but not limited to maternal and child 
health, to clients of all ages living in their areas. 



SERVICES AND STRATEGIES 

Some rural clinics reported special maternal and child 
services within broader programs. The Perinatal Pro- 
gram of the Northern Sacramento Valley Rural 
Health Project (NSVRHP) in Olivehurst, California, 
is a good example: 

• TheNSVRHP Perinatal Program provides ac- 
cess to comprehensive maternal and child 
health care. Our services are available to all 
expectant mothers including the medically in- 
digent, those with cultural barriers, those who 
have need for extra counseling, and other 

underserved mothers Through early 

identification and increasing the com- 
prehensiveness of the prenatal care, we hope to 
help prevent prematurity and the incidence of 
low birth weight babies. 



Rural clinics have devised various means for reaching 
and caring for their clientele who may live far from the 
clinic and may not have access to transportation. In 
some rural programs, visits to the clients' homes pro- 
vide follow-up to clinic visits and an opportunity for 
counseling. Many rural patients live far from the cli- 
nics serving them and do not have access to public 
transportation. Other rural clinics, such as that of the 
Charles City County Health Department in Charles 
City, Virginia, provide transportation to and from 
clinic appointments. 

STAFFING 

Use of allied health personnel and medical-health 
teams. Several survey respondents mentioned use of a 
team of health care providers. Teams may consist of 
one full-time physician assistant and a part-time 
physician, as in the Truchas Clinic in Truchas, New 
Mexico, or of a physician, nurse practitioner, nutri- 
tionist, pharmacist, and health educator as in the 
Community Health Clinics of Nampa, Idaho. The 
Matthew Walker Center in Nashville, Tennessee, 
wrote, "A team approach of an obstetrician/ 
gynecologist, pediatrician, geneticist, nutritionist, 
and social worker makes a perfect combination." 
Other health personnel mentioned by survey respon- 
dents included nurse-midwives and community peer 
counselors. 

Peer Counselors. Many respondents use local 
women trained in outreach to help cope with problems 
of communication. Two programs that recruit peer 
counselors from the community are: 

• The Northwest Michigan Health Services, 
Migrant Health Patients Program in Traverse 
City, Michigan, has used a State grant to hire a 
peer advocate, "someone who came from the 
bicultural migrant life experience but who had 
acculturated into the host community." The 
peer advocate is paired with a health educator 
and together they interview each prenatal 
client at the clinic and visit her at the migrant 
camp. The pair also visits each client at the 



64 



RURAL POPULATIONS 



hospital at the time of delivery and later makes 
a postpartum visit to the camp, if possible. With 
this approach the number of newborns requir- 
ing intensive care has decreased and 
breastfeeding has increased dramatically. In 
addition, stereotypes on both sides have been 
broken down and appreciation — of the mi- 
grant workers for the clinic and of the staff for 
the migrant culture — has increased. For the 
1985 migrant farm worker season, the pro- 
gram has received assistance from medical stu- 
dents placed by the American Medical Stu- 
dents Association with Federal funding. They 
report that "pre-clinical medical students are 
generally well motivated and, with direction 
and supervision, can provide a great amount of 
quality information and guidance for our 
clients." 

• The Maternal Infant Health Outreach Work- 
er Project (MIHOW) is a network of outreach 
workers in three states: Tennessee, Kentucky, 
and West Virginia. With funding from the 
Ford and Robert Wood Johnson Foundations, 
this project has trained women from the com- 
munities to make home visits to pregnant 
women and infants under the age of 2. Working 
with support groups and maintaining a link- 
age between providers and clients is also the 
role of these "natural helpers." The women re- 
ceive 1 day of training each month in health 
issues, child development, home visits, group 
work, parenting skills, and record keeping. An 
experienced outreach worker accompanies 
them on their initial visits, then meets with 
them regularly to discuss progress and prob- 
lems. Evaluation is an ongoing part of this 
program; data is collected regularly by the peer 
counselors and will be compared with data 
from a baseline survey conducted in 1983. Pre- 
liminary results show significant increases in 
breastfeeding, use of prenatal care, and other 
health indices. 



Staff burnout. Burnout is a problem faced by the 
Maternal Infant Health Outreach Workers (MIHOW) 
in Nashville. Its 1985 Progress Report describes the 
problem vividly: 

• As health providers who visit clients in their 
homes (the workers) confront the day-to-day 
reality of people living in housing that is 
crowded, cold in winter, and hot in summer. 
Many of the people they serve are not able to 
feed their families as the end of the month 
approaches. Child abuse, spouse abuse, 
neglect, depression, and fear are seen by the 
professional MIHOWS regularly. 



The report goes on to describe ways of dealing with 
this job-related stress: 

• We have structured bimonthly group train- 
ing sessions as one way to relieve the stress of 
the work as well as to provide formal training. 
However, the on-site involvement of three to 
four natural helpers (peer counselors) who 
approach the MIHOW project with new excite- 
ment and energy, has proven to be the best 
antidote. 



OUTREACH 

The most difficult obstacle health professionals serv- 
ing rural Americans confront is communication. Dis- 
tance, as was mentioned previously, makes it difficult 
for clients to reach health care facilities and, at the 
same time, health care workers find it difficult to find 
either the time or money for going to their prospective 
patients. Differences in lifestyle and cultural outlook 
pose yet another problem. Well aware of the chal- 
lenges they face, survey respondents emphasized that 
they have found solutions that work: 

Public awareness. Word-of-mouth was the most fre- 
quently mentioned means of letting clients know 
health care services are available. Some respondents 
advertise their services on local radio and television 
services, while others rely on civic and church groups 
to spread the word. Community settings, such as 
schools, recreational facilities, and health fairs are 
also good sites for promoting awareness of medical 
services. Sending clinic staff to schools and communi- 
ty gatherings is a strategy one program uses. 

Networking. Coordination with other groups is an 
essential element in program success, according to 
many respondents. "Networking on a local grass roots 
level is what makes it work," commented the Sarasota 
County Migrant Health Service in Sarasota, Florida; 
its primary care program is coordinated with the coun- 
ty's public health agency. The concept of networking 
was endorsed by the Sterling Area Health Project in 
Sterling, Michigan, which organized a community 
task force specifically to improve the outcome of pre- 
gnancies among the rural, low-income population of 
northern Michigan. Community groups coordinate 
prenatal classes, post-delivery educational programs, 
school reproductive health classes, and increased 
accessibility for low-income women to prenatal and 
related services. 

• "Many communities," wrote this program's 
director, "have resources/ services in this area 
but few tackle the problem with full community 
support. The task force format fully overcame 
this problem and resulted in active community 
support and full participation by the target 
group." 



65 



RURAL POPULATIONS 



NEEDS FOR EDUCATIONAL MATERIALS 

Most survey respondents indicated needs related to 
their predominant problem — improving communica- 
tion. The need for culturally relevant materials was 
foremost: "more in Spanish with Spanish faces;" "we 
need birth control and sex education material appro- 
priate for use in southern Black churches;" "materials 
developed specifically to address the health problems 
of migrant farmers." These quotes represent the mes- 
sage repeated in many survey responses. Other re- 
spondents requested up-to-date childbirth films; low- 
cost audiovisual materials; and short waiting room 
cassettes on prenatal subjects. The Rural Infant Care 
Program in Oklahoma response summed up the prob- 
lem: 

• A wealth of patient education materials ex- 
ists. The challenge is finding those that fit your 
target group. What is missing is an easy-to- 
follow guide that teaches how to select materi- 
als for the population targeted. 

Other needs mentioned by rural programs were 
logistical: help with transportation and ways to reduce 
waiting room time; access to more services. Migrant 
programs said that they need ways to recruit staff on a 
seasonal basis and to respond to unpredictable health 
needs and caseloads. 



ADVICE AND OBSERVATIONS 

The two most often mentioned pieces of advice for 
other programs were the need to involve the communi- 
ty and the need to understand the client. Clinics found 
that communicating with other community services 
and coordinating services offered reduced duplication, 
increased community cooperation, and expanded ser- 
vices available to their clients. 

Understanding the population served, including their 
needs and attitudes, was also seen as critical. One 
clinic suggested including members of the population 
in planning services and carrying out programs. Many 
recommended the use of peer counselors, the use of 
simple, attractive visual materials, and materials or 
instruction especially prepared for low-income pop- 
ulations. 



FETUS®: A Game to Promote Good Health 

This is one playing card used in the game Fetus ® 
developed by the Hudson Head Waters Health Net- 
work, North Creek, New York, for use with their 
prenatal self-help group. The winner of the most 
games over a 4-month period will receive a (don- 
ated) layette. For more information on this game, 
which is copyrighted, contact Shirley Andersen, 
Hudson Headwaters Health Network, Box 137, 
North Creek, NY 12853. 




A game 

to promote 

good 

health. 



DDD 



66 



NATIVE AMERICANS 



11 

Native 
Americans 



Forming a small but distinct category, these 36 survey 
responses came primarily from programs sponsored by 
the Indian Health Service (IHS), a system of care dif- 
ferent from that available to other low-income women. 
These services for American Indians and Alaskan Na- 
tives are based in clinics which for the most part have 
been established and funded by the IHS (a part of the 
U.S. Public Health Service). Only a few respondents 
cited other Federal and non-Federal sources of funds, 
such as Native corporations. 



SERVICES AND STRATEGIES 

Most survey respondents provide basic clinic services, 
and some offer prenatal or postnatal classes. But many 
also offer one-to-one counseling in homes because of 
the problem of distance and because their clients tend 
to be reticent in group situations. A good example of 
these programs is the Prenatal Clinic in Lodge Grass, 
Montana. With the goal of improved pregnancy out- 
come for Native American mothers and infants, the 
program includes: 

• Regular prenatal clinic visits with exam by physi- 
cian; 

• Education provided by a community health nurse, 
clinic nurse, and nutritionist; 

• Education and follow-up in home by community 
health nurse during prenatal and postnatal period; 

• Referral to WIC program on site, available same day 
as prenatal clinic; 

• Prenatal questionnaire given by community health 
representative prior to first prenatal visit; 

• Postnatal questionnaire completed at WIC visit if 
client is on WIC program; 

• Referral to community health nurse if prenatal 
client doesn't attend the prenatal clinic; a home visit is 
made, and the client is encouraged to attend the clinic. 

In addition to clinics and home visits, survey respon- 
dents have devised various ways to attract clients and 
make their programs meaningful to their Native 
American clients. The Montana clinic described above 



has developed prenatal and postnatal questionnaires 
to identify each client's educational needs. Other 
special services described by survey respondents in- 
clude these: 

Single mother support group. The Indian Health 
Care Resource Center in Tulsa, Oklahoma has started 
support groups such as "Baby's Lib" for its large num- 
ber of single mothers. This strategy, combined with 
home and community outreach, appears to be work- 
ing: 

• When we began prenatal care in 1977, 80 
percent of the pregnant women were presenting 
themselves at the end of the third trimester or in 
labor. In 1978-1980 it was reduced to the 
second trimester. By 1982, (women were) com- 
ing in for pregnancy tests. 

Environmental health services. In addition to the 
direct health services, the Navajo Area Indian Health 
Service, Office of Environmental Health (OEH), has 
been instrumental in developing safe water supplies 
and waste disposal systems across the reservation. 
There has been a significant reduction in infant deaths 
due to diarrhea and gastroenteritis as a result. OEH is 
presently developing a safety and injury control pro- 
gram (infant car seat program in place) at all service 
areas. 



STAFFING 

Knowledge of and sensitivity to client cultural and 
social patterns is inevitably an important factor in the 
success of maternal-child health programs serving 
minorities. Health workers from the community seem 
to contribute to program effectiveness. 

The San Francisco Perinatal Program seeks to staff its 
program with Native Americans: 

• Cultural appropriateness and sensitivity is 
critical to the success of a program which serves 
a special (i.e., minority) population. As much 
as possible, staff is recruited who are of Indian 
heritage and who have experience with urban 
Indian clients. Materials and approaches to 



67 



, 



NATIVE AMERICANS 



care are sensitive to Indian culture whenever 
possible. We utilize other Indian agencies and 
participate in their programs as much as possi- 
ble. 

Another program called Healthy Mother, Healthy 
Baby in Saskatoon, Saskatchewan, reported a similar 
approach: 

• The contribution of the Native health work- 
ers to the program's success has proven to be 
invaluable. In the past, the Health Unit's con- 
ventional prenatal services were unable to 
attract Native women. Services were not con- 
sidered accessible or acceptable to Native 
women and the groups and agencies represent- 
ing these women were not comfortable in mak- 
ing referrals. Healthy Mother, Healthy Baby 
made available culturally appropriate counse- 
lors to provide support and education to Native 
women in pregnancy. It is the existence of the 
Native health workers that has secured pro- 
gram acceptance within the Native community. 



OUTREACH 

The San Francisco Perinatal Program is actively in- 
volved in recruitment of patients: 

• Perhaps the most unique feature of the pro- 
gram is our outreach component. Extensive 
community involvement to recruit patients in- 
cludes participation in community events... 
presentations. Patient follow-up is also exten- 
sive, with staff phoning, writing, and making 
home visits to noncompliant patients, and 
much effort made to inidivdualize all aspects of 
care. Reports this respondent, "We have 
observed a higher percentage of timely entry to 
care and compliance to appointment schedules 
than expected." 



EDUCATIONAL PROGRAMS 

Classes combined with clinics. The Keams Canyon 
Public Health Service Hospital reported that it gives 
30-minute prenatal classes before each prenatal clin- 
ic, presented by volunteer childbirth educators who 
live on the reservation. A similar parenting class has 
recently been started before the well baby clinic. The 
advantage of this program, wrote this respondent, is 
having a captive audience; the disadvantage is the 
short amount of time for the class and a lack of money 
for educational materials. As evidence of the strat- 
egy's success: 

• A small number of women have approached 
the 'teachers' for more individualized discus- 
sion. This is a major accomplishment. Some 



women have asked one of the teachers to help at 
their birth as a labor support person. 

Other respondents confirmed that classes and other 
special attention often encouraged patients to begin 
asking for individual counseling. 



NEEDS FOR EDUCATIONAL MATERIALS 

Culturally relevant, simply written, large-print mate- 
rials were the need most often cited by respondents 
associated with Native American women and men. 
Specialized materials are needed for single parents 
and for men who need information about family plan- 
ning. Some of the topics respondents mentioned are: 
parenting and bonding; nutrition, including informa- 
tion on the basic four food groups, and infant feeding; 
breastfeeding; Fetal Alcohol Syndrome; and diabetes. 

The Public Health Service Indian Hospital in Albu- 
querque, New Mexico, and the Indian Health Center, 
Wewoka, Oklahoma, have produced audiovisuals to 
reinforce their messages and promote better nutrition, 
but survey respondents emphasize that funding con- 
straints limit their access to materials that are avail- 
able. 

Acknowledging that producing tribe-specific materi- 
als would be difficult and prohibitively expensive, one 
respondent suggested that professional education 
materials for those working with Native Americans, 
especially information focusing on motivating clients 
and offering practical suggestions, would be ex- 
tremely useful. 



ADVICE AND OBSERVATIONS 

The Milwaukee Indian Health Board offered this 
advice to others: 

• Prior to planning and implementing new 
programs, there definitely has to be an assessed 
and expressed need. ..You will meet with great- 
er success if a survey/questionnaire form is 
circulated to targeted populations and you 
formulate programs based on the feedback 
. . . .Do a lot of networking to avoid duplication . . . 

Other programs echoed their advice and offered these 
suggestions: 

• Have a mental health counselor teach a par- 
enting class in conjunction with a pediatrician. 
Dedicate one entire session with the pediatri- 
cian to parents' questions. (Little Boston Klal- 
lam Health Center, Family Practice, Kingston, 
Washington) 

• Repetition is the mother of learning but even 
in repeating use different audiovisual aids and 
have a different approach. Analogies work very 



68 



NATIVE AMERICANS 



well. Demonstrations, slides, pictures, ex- 
periments make it real. (Indian Health Center, 
Wewoka, Oklahoma) 

• Use food models and slides of foods to teach 
nutrition. (PHS Indian Hospital, Albuquer- 
que, New Mexico) 

• With a more vigorous insistence by physi- 
cians to attend an appropriate group/class, our 
client participation level has increased notice- 
ably. (Milwaukee Indian Health Board, Mil- 
waukee, Wisconsin) 

• We give them a card to get in touch with us (in 
addition to) home visits. Working closely with 
the client and showing that we care has made 
our program a success. (Carl Albert Indian 
Health Facility, Ada, Oklahoma) 

• Establishing college credit for training has 
helped make it more attractive for students. 
(Alaska Area Native Health Service, An- 
chorage, Alaska) 




Indian Health Service, Public Health Service 



DDD 



69 



ADOLESCENT PREGNANCY 



12 

Adolescent 
Pregnancy 



Adolescent pregnancy is a widespread and growing 
problem, and virtually every category of this com- 
pendium includes programs that assist teens. But pro- 
grams that focus exclusively on pregnant teenagers 
and teenage parents also responded to the survey in 
large numbers. These 174 respondents pointed to sta- 
tistics showing that teenage mothers and their infants 
face a greater risk of health complications and are less 
likely to receive care than women over 20. They 
emphasized the psychosocial problems that ex- 
acerbate, almost overshadow, the health risks of teen- 
age pregnancy. Teen mothers, they said, are more 
likely not to finish school, to be unemployed, to be 
neglectful or abusive parents, and to commit suicide. 

Repeatedly respondents stressed the importance of 
building the teen's self-esteem and positive self- 
image. They wrote convincingly and with compassion 
of their clients' need for support and a trusting 
relationship with an adult. Here is an extract from the 
program description of Child and Family Health Ser- 
vices in Cincinnati, Ohio: 

• These young parents are still children them- 
selves. They need all the support and reassur- 
ance that adults can offer in order to see that 
they come through the experience of pregnancy, 
delivery, and total readjustment. These teen- 
age parents have some hope that they will be 
able to go on toward successful adulthood and 
productive living. Special counselors need to be 
able to give caring, love, compassion, and 
understanding to help teenage mothers avoid 
being trapped into permanent defeat or total 
punishment long before they can be expected to 
cope. 

Another respondent, The Area Service Association in 
Hazel Park, Michigan, offered this analysis of the 
challenge facing adolescent pregnancy programs: 

• An increase in the birth rate for this popula- 
tion and the lack of intensive and coordinated 
support services have caused the need. ...Our 
assessment for this population is that the 
mother and her child will become permanently 



disadvantaged and dependent upon public 
assistance (95 percent of our clients are receiv- 
ing AFDC). They are physically, socially, and 
economically isolated and lack positive life ex- 
perience. They have no basis to become parents, 
lack any type of future orientation, and will 
ultimately continue a pattern of failure. They 
are not involved in other programs or services 
as they are most often school dropouts and 
standard social service outreach efforts are 
totally lacking. * 

Funding for adolescent pregnancy programs is pro- 
vided most often, according to the survey, by State and 
local governments followed closely by "agency/ 
organization budget." TOPPS (Teen-Obstetrical- 
Perinatal-Parenting Services), part of a clinic spon- 
sored by the University of Arkansas Obstetrics/ 
Gynecology Department in Little Rock, is typical of a 
program funded by its parent organization, showing 
how "at least some sort of program can be done without 
extramural funding within an existing program by 
rearranging scheduling of patients and locating per- 
sonnel with a special interest in working with adoles- 
cents." (See the description of this program under Peer 
Settings). Programs also cited Federal funding and 
foundation funding, in approximately equal numbers, 
but these were a definite minority. Voluntary organi- 
zations, such as the National Urban League, the 
United Way, and the Salvation Army provide funding 
for some programs. 

Programs responding to the survey form several 
groups: school programs, clinic or hospital programs, 
residential programs and other approaches. 

SERVICES AND STRATEGIES: 
SCHOOL PROGRAMS 

Keeping pregnant teens and teen mothers in school 
was a prime goal of many survey respondents. Various 
strategies are employed from providing part-time 
counselors to offering completely separate programs. 
Special classes in the public schools may combine pre- 
natal and parenting education with regular academic 
subjects. 



70 



ADOLESCENT PREGNANCY 



Mainstreaming. Providing free day care and trans- 
portation while teen parents attend a regular school is 
the approach taken by two respondents: 

• The School -Age Parent Program in Ypsilan- 
ti, Michigan, provides a "support system to help 
pregnant adolescents and school-age parents 
remain in school and graduate." The regular 
school program is supplemented by a special 
prenatal and parenting skills class. This pro- 
gram reported some evidence of success: "Un- 
like the national average of dropouts of preg- 
nant students which is 80 percent, our dropout 
rate is only 20 percent. In addition we have had 
no low -birthw eight babies or infant com- 
plications among the students who remain in 
school and take the special class." In favor of 
mainstreaming, this respondent added, "It 
does not isolate the pregnant students from 
their peers and allows them to take a wide 
variety of classes. In addition, the de- 
velopmental tasks of adolescence are more easi- 
ly achieved by being in a regular high school." 

• The Young Families Program in Billings, 
Montana, allows teen parents to spend half 
their day at a special center and half in a reg- 
ular school. "The school-age parent is able to 
bring her/his child to the Parenting Center by 
7:30 a.m. The parent can then remain at the 
center for periods 1, 2, 3 of the school day. 
During that time, the student will experience 
such activities as parenting classes, group and 
individual counseling, self-esteem activities, 
health care instruction, and supervised time 
with her/his child. At the end of the third peri- 
od, the students will be transported to their 
home junior or senior high school for lunch 
and academic periods 4, 5, 6.... The schedule 
which the teenage parents will follow parallels 
that of students attending the Career Center. 
Thus, it will not seem unusual for the teenage 
parents to be out of their home schools for part 
of the day. At the end of the school day, the 
young parents will be transported to the Par- 
enting Center to pick up their infants. The par- 
ents will be responsible for their own transpor- 
tation between the Parenting Center and their 
homes. ...it is predicted that the normalization 
model which the Young Families Program has 
chosen will have the important advantages of 
(1) keeping teenage parents in the educational 
and social mainstream, (2) providing more 
educational opportunities for teenage parents 
than alternative schooling can provide, (3) pro- 
viding high-quality day care for the infants, 
and (4) providing parenting instruction in a 
natural setting. 



ADOLESCENT PREGNANCY 

The basic struggle of each teenager is the same as 
for people everywhere; she needs and wants to feel 
loved, capable of love, and O.K. about who she is. 
Her feelings about herself, stemming from the 
family in which she has grown up, strongly affect 
her ways of coping with her transition into adult- 
hood. How her family functions and the systems her 
family uses to deal with stress are the basis of her 
own emotional development and responses to life. 
The teenager's pregnancy is often her response to a 
current family situation. Becoming pregnant may 
be the young woman's attempt, usually outside of 
her awareness, to solve a problem of her own or a 
problem of the whole family. 

She may be trying to: 

• show parents that she is separate from them and 
no longer in their control; 

• solidify a relationship with a young man and cre- 
ate a new family; 

• distract the family's attention from dealing with 
other critical issues; 

• get the family to pay attention to her needs and 
wants; 

• and, in the absence of a family, create a baby to 
love her and keep her from being alone in the world. 

A young woman's pregnancy is a response to her 
unique life problems. In addition to this response, 
there are normal development issues through 
which each adolescent must work. She is discover- 
ing and creating who she is, separate from her par- 
ents. She moves tenaciously back and forth from 
dependency to independence. She is touched by 
many expectations from peers and community, 
family and society, and many of these are con- 
tradictory. Her physical, emotional, and sexual 
identity become critical issues. (The Salvation 
Army Booth Memorial Home, Boise, Idaho) 



In-school clinics. Two respondents described pro- 
grams that provide prenatal health care at schools. 

• Project Moving-On in Providence, Rhode Is- 
land, established an adolescent clinic, the 
Rainbow Center, in an inner-city high school. 
The clinic offers medical care, counseling, and 
support and advocacy for pregnant and parent- 
ing teens. Peer counselors are often called upon 
to be advocates for the teens when dealing with 
local government programs. 

• The St. Paul Maternal and Infant Care 
Project in Minnesota provides prenatal care in 



71 



ADOLESCENT PREGNANCY 



four public high schools; the clinics also pro- 
vide adolescent pregnancy prevention and 
other health care services. The in-school clinics 
are successful, reported this respondent: "In 
spite of the documented high-risk population 
served, incidence of low birthweight is 8.6 per- 
cent in adults and 10.9 percent in adolescents 
(72 percent and 16.8 percent respectively for 
adults and adolescents in the general St. Paul 
population). The fertility rate has been signifi- 
cantly reduced in the high school population 
and there has been an improved pregnancy out- 
come, a low school dropout rate, and a low 
repeat pregnancy rate." 

Special classes in schools. Classes in prenatal and 
infant care are offered within the regular schools in 
some cases. 

• The Adolescent Pregnancy Program in West 
Ridge, Pennsylvania, funded by the March of 
Dimes, serves all teens in junior high schools in 
the Reading area and other areas if funding is 
available. The goal of the program is prenatal 
and postnatal health care. The program begins 
with teaching in the schools on an individual 
or small group basis and continues with a 
home program during the summer or for those 
who are homebound. 

• The Infant Care Course for Teen Mothers 
implemented by the School Age Mother Pro- 
gram in San Jose, California, is designed to 
utilize Red Cross nurse volunteers. The course 
is geared toward the girls' learning needs 
which were assessed by working with faculty 
and public health nurses from the school's day 
care center and observation of the pregnant 
teenagers working in the day care center. 

Visiting counselors. Providing special counselors in 
the schools is a strategy used by some programs: 

• Child and Family Health Services in Cincin- 
nati, Ohio, sends a trained counselor from the 
city's health department to ten schools for a half 
day each week to provide information, screen- 
ing, evaluation, counseling, and referral for 
pregnancy -related problems. The counselors 
also follow-up on referrals to assure that ser- 
vices were received. This is a joint project of the 
health department and the schools. The schools 
publicize the program, identify the students to 
be seen by the Visiting Counselor, and obtain 
the necessary parental consent. 

• The Salud New Horizons Adolescent Clinic 
in Fort Lupton, Colorado, uses a Federal 
Maternal and Child Health grant to finance a 
similar program that includes a special refer- 
ral mechanism. A nurse practitioner spends 
one morning a week in a local school, to identify 



high-risk teens in need of family planning, 
pregnancy tests, or prenatal care. Teens are 
referred to the Teen Clinic in town the next day. 
The program has found that 92 percent of the 
teens keep these next-day appointments, com- 
pared with a 44 percent compliance rate when 
teens make their own appointments by tele- 
phone. 

Alternative schools for teen parents. These pro- 
grams accept pregnant teens and let them continue to 
earn credits toward graduation. Day care is often pro- 
vided. The curriculum usually combines academic 
classes with parenting and career counseling. For ex- 
ample: 

• The Teenage Parents Center in Akron, Ohio, 
is an alternative educational setting for preg- 
nant teenage girls attending the public schools 
in Akron. The Center is sponsored by three 
agencies, Family Services of Summit City, the 
Akron Board of Education, and the Akron City 
Health Department. 

The students come from various cultural back- 
grounds, income groups, and educational 
levels. Approximately 79 percent are black. 
They may enroll at any time during their preg- 
nancy, and can choose to stay at the school for 
the entire year, even after delivery. (After deliv- 
ery the student is allowed a 3-week recupera- 
tion period and then must return to school.) 
The school also runs a licensed day care center 
that the student can use if finding child care is 
a problem. The Infant Center is a part of the 
school system's Early Childhood Development 
Vocational Program, open to 11th and 12th 
graders. 

Up to one year after delivery, both nursing and 
social services are offered to the girls. This has 
enabled the staff to assist the families and 
monitor the physical and emotional develop- 
ment of the children. 

• The Pontiac School District Teen Mother 
Program, in Pontiac, Michigan, combines the 
efforts of three agencies: the Oakland County 
Health Division, Family and Children's Ser- 
vices of Oakland, and the Oakland County 
March of Dimes. Its purpose is to offer 
"....alternative education, social and support- 
ive services to the pregnant teen, her infant, the 
father of the baby, and the extended family." In 
addition to educational credits, prenatal 
classes, and counseling, the program operates 
a licensed infant day care nursery for infants 
and toddlers. 

• The Teen Parent School Program of the 
Maine Children's Home (MCH) in Waterville 
is conducted in cooperation with the area 



72 



ADOLESCENT PREGNANCY 




SUPPORT GROUP TOPICS 

Support groups are among the services offered by 
some programs for pregnant or parenting teens. 
Here are some ideas for meetings: 

• Good conversation 

• I want to scream 

• What about me - the young mom 

• Why is my baby crying? 

• Look what my baby can do 

• Male role models for the child 

• Kids relating to kids 

• Ins and outs of public assistance 

• Legal issues 

• Birth control use and abuse 

• My child's sick — What do I do? 

• What is good food? 

• Exercise for moms 

• Craft projects 

• Holiday parties 

• Field trips 

(From The Area Service Association, Hazel Park, 
Michigan) 



school system. It combines two elements: a for- 
mal academic program with standard curric- 
ulum requirements, conducted by a certified 
teacher from the Wateruille School District; 
and a Prenatal/Infant Care Program directed 
by a certified teacher from MCH. The 13-week 
Prenatal/ Infant Care Program relies on re- 
source personnel including Lamaze Childbirth 
Educators and Registered Nurses specializing 
in Family Planning, Infant Care, and Child 
Development. Following the birth of the child 
the teenage mother reenters the school system 
(usually at a quarter break), but her adjust- 
ment is closely monitored by both MCH counse- 
lors and her high school guidance counselor. 

• The Family Learning Center, Leslie, Michi- 
gan, offers not only standard academic studies, 
but also programs for vocational testing, 
education, and placement. Located in the Cen- 
ter is a day care facility for infants and young 
children. A Supplementary Resource Center 
provides information on food and clothing 



banks, community interagency assistance, and 
counseling services. 

• The Teenage Alternate Pregnancy Program 
(TAPP) in Eatontown, New Jersey, has es- 
tablished a special program for pregnant stu- 
dents, housed in a separate building. "Aca- 
demic courses are mixed with a unique com- 
bination of pre- and post-natal instruction, 
home economics, consumer education, money 
and time management, and employability 
skills... Girls are encouraged to attend support 
groups. TAPP_staff maintain a strong liaison 
with local medical facilities to ensure students 
follow through with ongoing pre- and post- 
natal care." Students enrolled in this program 
remain in school until delivery, return 2 to 4 
weeks later, and continue until the end of the 
grading period, when they return to their reg- 
ular school. The school is funded partly 
through the public school system and partly 
through a State vocational education grant. 
Many local organizations provide direct ser- 
vices to the girls in the TAPP program as well. 
A partial list includes the YMCA for exercises, 
the Catholic Welfare Bureau for information 
on adoptions, Planned Parenthood, the Long 
Branch Health Department, and CLASP, a 
parent support group. Since 1983, attendance 
has increased from 9 to 72 students and over 80 
percent returned to their regular schools after 
their babies were born. 

• Teen fathers as well as mothers can attend 
the Char-Em Alternative Program for School- 
Age Parents in Charlevoix, Michigan. Stu- 
dents attend classes for approximately a year, 
including the semester after delivery. In addi- 
tion to regular academic and health education 
courses, the program uses an English Commu- 
nications Course to provide group counseling. 
In a rural area, this program found that pro- 
viding transportation was a necessity. "This 
increases the budget greatly, but the positive 
end results are well worth the cost." The im- 
portance of community support was empha- 
sized by this respondent. The program has an 
advisory board and uses speaking engage- 
ments, slide presentations, student panels, and 
media coverage to keep the community in- 
formed. In 1979, a 5-year follow-up study was 
conducted and distributed to all area schools, 
agencies, and organizations. "The study gave 
the community feedback, education, and hope," 
wrote the respondent; a 10 -year study is cur- 
rently underway. Evidence of success up to now 
is found in the high percentage of students 
returning to their regular school to graduate 
and the high birthweight of their infants. 



73 



ADOLESCENT PREGNANCY 



SERVICES AND STRATEGIES: 
CLINIC PROGRAMS 

Clinic-based programs emphasize psychosocial ser- 
vices as well as health care for adolescents. The Johns 
Hopkins Adolescent Pregnancy and Parent Program 
in Baltimore, Maryland, for instance, provides "medi- 
cal, psychosocial, and health and parenting education- 
al services to adolescents throughout pregnancy and 
for 3 years thereafter.... Services are provided through 
a multi-disciplinary team using a case management 
approach. ...Strongly emphasizing values clarifica- 
tion, decision-making skills, and utilizing extensive 
community linkages has enabled the program to be 
highly effective with its teenaged parents, their chil- 
dren and families." In addition to obstetricians and 
nurses, a social worker, a health educator, and a com- 
munity outreach worker are assigned to the program. 
At each clinic visit, the teenager and those who accom- 
pany her attend an educational group session. 

Other clinics described these approaches: 

Mother/baby programs. Several respondents, in- 
cluding the Johns Hopkins Program just cited, de- 
scribed clinics that care for both the adolescent and 
her baby at the same visit. For example: 

• The Adolescent Pregnancy Program in 
Jamaica, New York, addresses the health care 
needs of adolescents seeking prenatal, family 
planning, and follow-up care. A team of medi- 
cal social work and nursing personnel provide 
psychosocial counseling, a full range of contin- 
ual prenatal services including postpartum fol- 
low-up and family planning, comprehensive 
pediatric care and an intensive series of out- 
reach and follow-up services for teens and their 
parents. 

Peer settings. A number of clinics have instituted 
adolescent pregnancy programs that bring the teens to 
the clinic and associated classes at the same time, 
because, as Comprehensive Adolescent Pregnancy 
Services in New Brunswick, New Jersey, wrote, "preg- 
nant teens are much more comfortable in a peer set- 
ting, rather than being seen with adults." 

• Peer support has been formalized by the 
Camden County Adolescent Family Life Pro- 
gram in Camden, New Jersey, which reported 
that "most clinical sites now have successful 
teen assistant programs, where peers work 
with peers to optimize program impact. At 
some sites, client groups have evolved into sup- 
port groups for the adolescent parent, thus 
minimizing some of the social isolation often 
experienced by this population, and further 
encouraging productive activities such as a re- 
turn to school." 



• TOPPS, in Little Rock, Arkansas, wrote, "as 
one of the first objectives was to encourage clin- 
ic attendance, we altered several standard clin- 
ic routines in an effort to make the clinic more 
appealing to teens. The first clinic visit was 
held on a different day from routine clinic and 
a special orientation session was in- 
cluded... Each visit is preceeded by a group 
session facilitated on a rotating basis by team 
members.... The clinics have been scheduled on 
a day when the OBIGYN department is in 
meetings so there are no other patients in the 
clinic and time can be taken with the teens." 
Girls in the TOPPS program have been com- 
pared to a group of teens delivering at the same 
hospital but not attending the TOPPS clinic. 
The TOPPS teens had an 11 percent rate of 
prematurity, compared to a 21 percent rate for 
the control group. The incidence of Caesarean 
and difficult deliveries was also lower for the 
TOPPS group. 



SERVICES AND STRATEGIES: 
RESIDENTIAL PROGRAMS 

A hybrid approach, combining academic and practical 
training with health and social services is typified in 
the residential programs for pregnant teens sponsored 
by Florence Crittenton Services, The Salvation Army, 
and other well-known organizations. 

All emphasize intensive counseling, therapy, and 
practice in independent living. Some of the goals of 
The Salvation Army Door of Hope Maternity Program 
in San Diego, California, for example, are "to provide a 




Human Services Inc./Florence Crittenton Teen Parent Education Network 



74 



ADOLESCENT PREGNANCY 




Human Services Inc./Florence Crittenton Teen Parent Education Network 

wholesome environment, to promote interpersonal re- 
lationships,. ...to encourage and facilitate education 
and job training, to maintain and restore supportive 
family relationships." 

Some residential programs, such as Louise Wise Ser- 
vices in New York City, offer a respite for young 
mothers, providing child care, a place to live, and 
social services while they finish high school or begin a 
career. The Crittenton Center of Family Counseling 
and Services in Columbus, Ohio, for example, provides 
both residential and day services to pregnant girls. 
Residential programs include: 

• TheVivianE. Washington Residence in Bal- 
timore provides a home for adolescent mothers 
and their babies. "Although many adolescent 
girls have made the decision to keep their child, 
they have not begun to deal with the multi- 
faceted complexities that a child brings to their 
lives. The girls are assigned specific personal, 
housekeeping, and parenting responsibilities, 
and daily evaluations track their progress in 
fulfilling these. Funded by the Baltimore City 
Department of Social Services, the Residence 
also receives $85 rent per month from each 
client; the client may pay the rent from Aid for 
Dependent Children (AFDC) funds. This pro- 
gram makes a point of including the baby's 
father, by establishing special visiting hours 
for fathers only. 

• The Salvation Army Door of Hope Maternity 
Program provides both medical care and social 
services to pregnant girls. Among its goals: "to 
encourage and facilitate education and job 
training" and "to assist in planning postpar- 
tum living situations." This program reported 



that of the 42 births through its clinic in 1984, 
there were only two Caesarean deliveries and 
no babies weighing less than 5 pounds. How- 
ever, it commented, "This type of program 
would be difficult to manage without the assis- 
tance of a large social service agency such as 
The Salvation Army. The program works be- 
cause of the on-grounds clinic and the access to 
graduate student interns." 

SERVICES AND STRATEGIES: 
OTHER APPROACHES 

Several programs responding to the survey are neith- 
er school nor clinic-based. These approaches are small- 
er in scope, and encompass a wide spectrum of ser- 
vices. 

Peer counseling. Teens counseling teens is the con- 
cept behind PACT (Peer Approach Counseling by 
Teens), a program of the National Board, YWCA of the 
USA, in New York City. The program, being con- 
ducted in several communities by local YWC As, trains 
teens in communication skills and on issues concern- 
ing sexuality. The teens then lead group discussions, 
sometimes at their schools, but often in other agencies 
and at the local YWCA. Some organizations have fo- 
cused on parenting or pregnant teens while others 
have focused on prevention of unwanted pregnancies. 

Teen panels. Expectant Teen Outreach in In- 
dianapolis, Indiana, has a teen panel that makes pres- 
entations to schools, churches, community groups, and 
local agencies. The panelists explain what it's like to 
be a teen parent. This program which is operated by 
Homes for Black Children, an adoption agency, also 
offers support groups for pregnant teens. 

Telephone information. Tel-A-Teen/Tel-Aid spon- 
sored by the Health Education Center in Pittsburgh, 
Pennsylvania, is a system of tape-recorded messages 
for teens, directed especially to low-income teenage 
girls. Topics such as drugs, self-image, stress, teenage 
sex, pregnancy, and parenthood are addressed. 

Male Involvement. Special counseling for young 
fathers and special efforts to involve fathers were 
mentioned frequently in these survey responses. A 
particular example of male involvement is provided by 
the Teen Parent Education Network in Denver, which 
offers separate classes for fathers: "This is a time when 
young fathers can discuss what is happening to them, 
make plans for the future, and learn about resources 
available to them for continuing their education or job 
training." 

Free loan closet. The Adolescent Pregnancy Project 
in Skowhegan, Maine, a home visiting program of the 
Kenneble Valley Community Action Program, main- 
tains a free loan closet stocked with infant and toddler 
clothes, maternity clothes, baby furniture, bedding, 



75 



ADOLESCENT PREGNANCY 



household items and toys for the use of its clients. It 
also sponsors a car seat rental program. The project, 
which is primarily a counseling and support service, 
receives referrals from doctors, hospitals, social ser- 
vice agencies, and schools. 

One-to-one support. Two survey respondents de- 
scribed different kinds of programs that focus on in- 
dividual counseling and support. 

• Project Prepare in Lynn, Massachusetts, uses 
Parent-Aides, "mature women who work as 
volunteers with their assigned family, provid- 
ing a role model and support for young, iso- 
lated parents." A Parent-Aide commits herself 
to a parent for at least 1 year, spends time with 
her weekly, is available by telephone, and plans 
joint activities, such as shopping. Training is 
provided to these volunteers and they meet in a 
"supervision group" every 2 weeks. The Parent- 



Aides are reimbursed for expenses and 
mileage. 

• The Adolescent Pregnancy Project in 
Flemington, New Jersey, provides individual 
counseling and education to pregnant teens in 
their homes and schools. Fathers and families 
may be included. Funded by the March 
ofDimes,this program individualizes counsel- 
ing for each client, using a curriculum de- 
veloped specifically for pregnant teens. Topics 
include prenatal care, decision-making, new- 
born care, family planning, and gynecologic 
health. Clients are recruited through the media 
and community groups. The past 5 years, said 
this respondent, have seen an increase in 
casefinding and "good compliance by clients in 
keeping appointments, completing assign- 
ments, and generally altering poor lifestyle 
habits." 



GOALS FOR PREGNANT ADOLESCENTS 



• Raising a young woman's trust level is crucial, 
especially with those from homes where not trust- 
ing is a survival skill. As long as a girl is not trust- 
ing others, she is not able to take in the caring and 
guidance which are being offered to her. She needs 
to learn that there are trustworthy adults in the 
world, how to distinguish which ones they are, and 
to come to trust herself. A part of learning to trust is 
knowing that it is O.K. to have feelings, to express 
feelings in appropriate ways, and to use these feel- 
ings to solve problems. 

• Helping a resident to see and respond to the real- 
ity of her situation is another part of the growth 
while at Booth Memorial Center. Adolescents fre- 
quently use denial and unrealistic fantasy as cop- 
ing mechanisms, especially in regard to their fami- 
lies, their boyfriends, and their future. Consistent 
and caring confrontation of reality by staff is neces- 
sary to help each young woman live and deal with 
the real world. 

• Developing good decision-making skills is impor- 
tant for the pregnant adolescent. Her decision to 
keep and parent or release her infant for adoption 
will have lifelong ramifications for both herself and 
the baby. She is handicapped by having too few of 
life's experiences behind her to help her make a 
wise decision. Preparing emotionally to deal with 
the results of her decision, plus acquiring the skills 
she will need, such as parenting and independent 
living skills, are a part of the Booth Memorial Cen- 
ter program. 



• There are many physical and psychological 
changes that occur during pregnancy. Helping the 
young woman understand these changes and being 
supportive of her while experiencing them are an 
integral part of the Booth program. Increasing her 
understanding of the various aspects of pregnancy, 
and helping her face the reality of its existence 
greatly increase the possibilities for a positive phys- 
ical and emotional outcome for both herself and the 
baby. 

• Helping a young woman explore her sexual iden- 
tity is another goal of the Booth program. Questions 
such as who she is as an emerging woman, what her 
value system is, how her body functions, how to 
prevent pregnancy, and how she chooses to relate to 
men, both past and future, are examined. 

• For many residents, their families are an es- 
sential part of their growth process. If a young 
woman is a part of a family system, the same system 
needs to be available and reactive to her and to the 
staff while at Booth Memorial Center. It is impor- 
tant for both the young woman and the family to 
prepare for her return home. For a resident who is 
not returning to her family, it is important to help 
her learn how to create a new support structure for 
herself. 

• We believe each young woman is trying to find 
ways to live and successfully cope with her environ- 
ment. It is our goal to help the emerging woman find 
new and better ways to live and grow in the world. 

(From The Salvation Army Booth Memorial Home 
in Boise, Idaho) 



76 



ADOLESCENT PREGNANCY 




Area Service Association 



OUTREACH 

Many communities have designed outreach programs 
outside of the schools and hospitals and clinics offering 
education and health services in a variety of settings 
— housing projects, recreation centers, day camps, 
churches, and community facilities. Examples are de- 
scribed below: 

• The Westside Adolescent Resource and 
Education Project (Project AW ARE) , initiated 
by a community health center in Tuscaloosa, 
Alabama, aims to reach not only adolescents 
but also their parents and the community at 
large. It has developed a Family Life Theater 
Group for teenagers. All plays depict realistic 
situations and problems confronting today's 
adolescents and are performed at local schools 
and recreation centers. Project AWARE has 
also initiated The Stork Club, a support group 
for pregnant teens and their partners. And it 
offers workshops, lectures, rap sessions, and 
presentations to special groups, civic clubs, and 
organizations. 

Home visits. Several programs assign home visitors 
to provide support to pregnant teens and teen parents: 

• The Chicago Comprehensive Care Center 
(4Cs) has a Home Visitors Program that util- 
izes paraprofessionals supervised by a social 
worker. The paraprofessional makes home 
visits, linking clients with community services 
by providing information, reminders and es- 
corts. She also follows up on all referrals. The 
paraprofessionals are young women who were 



teenage parents themselves and who have ad- 
justed successfully to the situation. The Home 
Visitors Program is aimed at a high risk group 
of elementary school age and educable mental- 
ly handicapped mothers. The Center also has 
developed a Primary Prevention Program and 
Teen Pregnancy Program, providing educa- 
tion and counseling in the schools. 

• Opportunities for Pregnant and Parenting 
Teens in Rochester, New York, is a home-based 
program of Hillside Children's Center aimed 
at providing support services to pregnant 
adolescents and adolescent parents living in- 
dependently or with their families. The pro- 
gram's goals are to prevent unnecessary place- 
ments, to strengthen family units, and to pre- 
vent repeat teen pregnancies. Services provided 
include intensive counseling, home visits, ser- 
vice plan, facilitation of use of community re- 
sources, and education in areas of parenting 
skills, child development, and coping skills. 

Visiting nurses. The High Risk Mother and Infant 
Program, a project of the Visiting Nurse Association 
in Pittsfield, Massachusetts, offers pregnant teens 
various services including childbirth preparation, pre- 
natal and postnatal nursing care, physical assessment 
of the baby, parenting skills, nutrition assessment and 
education, and monitoring of growth and develop- 
ment. This group also provides prenatal classes and 
makes its services available in a school for pregnant 
teens in Pittsfield. 

Networking. As one Coalition reviewer noted, these 
replies repeatedly emphasized the "necessity for link- 
age — networking involving the total community — 
schools, social service resources, health resources, and 
religious organizations." In some cases the network is 
on a national level, as in the National Urban League 
Affiliate Development of Adolescent Pregnancy/ 
Parenting Programs, based in New York City. This is 
a network among ten local affiliates of the League 
selected to receive concentrated technical assistance 
and financial aid to address adolescent pregnancy 
among Blacks. The ADAPP network shares training, 
advocacy, and information and is linked with other 
national, State, and local organizations. To measure 
their effectiveness, all ten programs will be evaluated 
"utilizing an impact evaluation model designed by the 
Southwest Regional Laboratories. This model allows 
service providers to measure change in participants in 
comparison to the entire community." 

Many local programs mentioned cooperative agree- 
ments between school systems, social service agencies, 
and clinics in their efforts to serve the diverse needs of 
teenage mothers. Several described broad community 
coalitions: 



77 



ADOLESCENT PREGNANCY 



• The Black Family Preservation Project in 
Kansas City, Kansas, was initiated by the Kan- 
sas Children's Service League's Black Adop- 
tion Program and Services with funding from 
the State's Department of Health and Environ- 
ment. Black community leaders met at the out- 
set of the program to discuss the causes and 
probable solutions to the high adolescent preg- 
nancy rate among blacks in Wyandotte County. 
The overall goal for the project is to bring down 
the rate by delaying early sexual involvement. 
Its program strategies include a volunteer 
speakers' bureau, teen workshops, and commu- 
nity networking. "The initial response of the 
community has been overwhelming acceptance 
of the project", reported this respondent. "In 
less than 6 months, the project has networked 
with 1 7 social groups and organizations and 
directly reached 350 youth and adults. Fifteen 
volunteers have been trained in our speakers' 
bureau." 

• The Consortium for Pregnant and Parenting 
Teens (CPPT) in Boston is comprised of many 
local service providers. State funds help sup- 
port this formal network, instituted to address 
the "pronounced problem of fragmented, dis- 
continuous services." The Consortium uses 
case management and liaison systems. "In con- 
junction with liaison representatives desig- 
nated by each member agency, case managers 
ensure that teens referred from services (e.g., 
medical, social, educational) to consortium 
and outside agencies are, in fact, receiving 
them." 




Johns Hopkins Children & Youth Programs 



The use of standardized referral forms and 
periodic meetings facilitates communication 
between the agencies. Member agencies also 
conduct extensive educational programs for 
clients, other adolescents, professionals, and 
community members. 

Preliminary assessments indicate that this net- 
work is indeed working. "Contact with a multi- 
tude of other local service providers (368 agen- 
cies) by the end of FY'84 indicates that per- 
sonnel were both aware of and willing to work 
with outside agencies." 

Their success has also been demonstrated in 
the number of teen clients participating in the 
clinic's services, other family members and 
male partners that have been counseled, and 
the number of participants in the community/ 
professional and school educational programs. 



EDUCATIONAL PROGRAMS 

Numerous respondents reported special classes for 
pregnant teens and new teenage parents. Most include 
the traditional subjects, such as nutrition, physiology, 
and infant care, and many also include units designed 
especially for adolescents. The Family Life Program in 
Trenton, New Jersey, for example, in its curriculum 
outline, lists units on "postnatal goals" and "feelings 
about pregnancy, motherhood" as well as an entire 
class on contraceptives. 

It's A New Life Teen Pregnancy Program in Appleton, 
Wisconsin, follows up its prenatal classes with post- 
natal support groups, one for teens keeping their 
babies and one for those releasing their babies for 
adoption. Other approaches to classes for teens: 

• Informal waiting room classes are a feature 
of the Winton Hills Medical Center. The Center 
has regular, group prenatal classes, but found 
that attendance was low. Therefore, between 
scheduled classes, an instructor works in the 
waiting room, showing films and cassettes, 
distributing educational materials, and 
encouraging patients to ask questions. "The 
no-show rate is decreasing and the clients are 
beginning to ask questions," reported this re- 
spondent. 

• Parenting classes for teens whose babies are 
in the neonatal intensive care unit were re- 
ported by the Facilitating Teen Parents Pre- 
mature Infant Interaction Program in Detroit, 
Michigan. Transportation is provided to the 
series of four weekly classes which include 
audiovisuals, printed materials, and a chance 
to try out the desired behaviors, such as tactile 
and verbal stimulation of the infant. Self- 
modeling photographs and a self-evaluation 



78 



ADOLESCENT PREGNANCY 



workbook "furnish motivation to continue the 
behaviors" after the classes are over. The 
Massey -Campbell Scale of Mother/Infant 
Reciprocity measures knowledge and skill 
retention. 

• Parents and Teens... Together, sponsored by 
the Philadelphia Urban League stresses the 
involvement of parents of pregnant teens in 
their eight-session prenatal education pro- 
gram. A notable part of this effort is its heavy 
male involvement — 49 percent of all partici- 
pants are males. 

• Teens-N-Tots, sponsored by the Peninsula 
Health District, Newport News, Virginia, is 
based on the concept that guidance and educa- 
tion on child development can reduce "stressful 
parent/child relationships and... prevent child 
abuse." This program teaches mothers how to 
stimulate their infants using sensory, kinesthe- 
tic, and visual methods; how to develop better 
cues as to their children's needs, and how to 
understand their children's growth and de- 
velopment. During the series of ten classes, 
mothers get acquainted with their children. 
Tots-N -Teens is seen as "a means of preventing 
future child abuse/neglect (by providing) par- 
ental knowledge of child development which 
influences expectations, actions, reactions, and 
interactions. Mothers often consider infants 
and children capable of accomplishing tasks 
before they are biologically ready and may 
punish them for non-compliance." 

Several adolescent pregnancy programs have de- 
veloped their own materials, which are described 
below: 

• Flyers on infant care and development have 
been written by The Johns Hopkins Adolescent 
Pregnancy and Parenting Program in Balti- 
more. With titles such as "Learning to Talk" 
and "Your Baby at Two Months," they give 
parents basic information in simple language. 

• The Tools for Teen Programs produced by 
The Salvation Army in New York (see "Tools 
for Teen Programs" in program listing) in- 
cludes lesson plans and backup materials for 
health education with teens. Of special interest 
to adolescent pregnancy programs are titles 
such as "Every Child Matters," about child de- 
velopment; "Education for Adulthood," for 
inner-city teenagers, including units on preg- 
nancy and birth; "Family Life Program," 
covering child growth and development; and 
"Manana," available in English and Spanish 
and covering child growth and development, 
guiding behavior, and children with special 
needs. 



• The Parent Express, a month-by-month 
newsletter for teenage parents produced by the 
Human Relations Program in Berkeley, Cali- 
fornia, was recommended by the Youth and 
Family Center in Lawndale, California. (See a 
description of this newsletter in the chapter on 
postnatal programs, under selected materials). 










Johns Hopkins Children & Youth Programs 



• The Youth and Family Center uses materials 
from several sources. These include: Parenting 
Skills: A Curriculum for Teenage Mothers 
from the Authority for Mental Health and 
Mental Retardation, 2501 Dunstan, Houston, 
Texas 77005; and parent education materials 
for low -income Latinos, "Familia En Flor" 
from the Parent Education Project, Harbor/ 
UCLA Medical Center, Research and Educa- 
tion Institute, 1000 West Carson Street, Cot- 
tage 15, Torrance, California, 90509. 

• A film, "Babies are People, Too" covers par- 
enting skills for teenage parents. Both this film 
and a curriculum guide, "Using Video to 
Teach Parenting Skills to Teenage Parents," 
are recent products of the Youth and Family 
Center in Lawndale, California. 

• A videocassette and participant workbook 
were developed to promote positive parenting 
between premature infants and their adoles- 
cent parents by a program at Saint John Hospi- 
tal in Detroit (see Facilitating Teen Parent/ 
Premature Infant Interaction, Detroit, Michi- 
gan in program listing). The same program 
has produced and copyrighted an AIDS Scale, 
an assessment tool to evaluate the quality of the 
interaction between parents and premature in- 
fants. 



79 



ADOLESCENT PREGNANCY 



• A text and workbook for group counseling, 
highly recommended by the C har-Em program 
in Charlevoix, Michigan, is See You At The 
Top, available from Positive Life Attitudes, 
13642 Omega, Dallas, Texas 75234 (800-527- 
0102) 

• Beyond the Birds and the Bees is a pamphlet 
on contraceptives developed by the Chicago 
Comprehensive Care Center in Illinois. 

• The YWCA also has developed "Choices or 
Chances," a game that presents role-playing 
situations. This "multifacted educational pro- 
gram" presents information on several topics, 
including human sexuality. Funded by the 
YWCA in Los Angeles to provide a "safe," 
somewhat structured environment in which 
young people can speak out easily or be silent 
and learn by listening to others. It is designed 
for 6 to 10 players, aged 14 or over, and for 
parents of teens. 



NEEDS FOR EDUCATIONAL MATERIALS 

Easy-to-read, low-cost materials (because as one re- 
spondent noted, being able to afford what is already 
available is a problem for many programs) were the 
most frequently cited "need" emerging from the sur- 
vey. 

Specialized materials are needed for Black rural 
teens, teen fathers, teens remaining with their fami- 
lies, and professionals working with disturbed teen 
parents. Topics mentioned frequently included: 

• Parenting infants and taking care of sick infants 
(Practical advice on taking an infant's temperature 
and determining if a young child requires medical 
attention were also mentioned.) 

• Child development 

• Simplified genetics 

• Risk factors in teenage pregnancy 

• Gestational diabetes 

• Finding jobs and breaking out of the welfare cycle 

One respondent noted a lack of materials on smoking 
cessation for the low-income audience. "Materials 
should be concrete, give practical suggestions, and 
take into account the constraints and stresses of pover- 
ty (that) affect smoking behavior." 

Audiovisual materials were another frequently cited 
need. Respondents need films especially directed to 
adolescents on family planning, labor and delivery, 
Caesarean section, basic anatomic and physiological 
changes during and after pregnancy, adoption, 
breastfeeding, and parenting. Spanish-language au- 
diovisuals are also needed. 



ADVICE AND OBSERVATIONS 

The most frequently given advice was to enlist the 
support of the community, to encourage networking 
among community agencies, and particularly to in- 
volve the schools as much as possible. Respondents 
often suggested that a variety of services be provided 
— including counseling, social services, and medical 
services — or that the program be located in a school, 
clinic, or hospital. The Chicago Comprehensive Care 
Center commented, "4Cs is able to work with a large 
number of pregnant teens successfully, because it is a 
special school-based program, and coordinated educa- 
tional, medical, and social services are readily avail- 
able and accessible to teens." The Char-Em program 
in Charlevoix, Michigan was equally emphatic: "The 
community support of area schools, churches, the 
health department, Planned Parenthood, March 
of Dimes, agencies, and private organizations has been 
vital to the success of the program." 

Many programs worked, said the respondents, be- 
cause of a dedicated and competent staff. The survey 
replies themselves reflected a high degree of personal 
involvement, and many respondents cited sensitivity 
to adolescent needs — along with hard work — as keys 
to success. It was recommended that the staff be avail- 
able for individualized service and frequent contact, 
that they be flexible, answer questions honestly, and 
"accept the girls where they're at and build self- 



TO AVOID PITFALLS 
IN A PARENT-AIDE PROGRAM 

• The Parent-Aide and Social Worker should 
have clearly defined roles and responsibilities. 

• The case information given to the Parent- 
Aide should be limited. 

• The Social Worker should explain to the client 
what a Parent- Aide is and how she can be of help. 
The Social Worker should invite the client to 
accept a Parent- Aide rather than coerce her. 

• The client should be able to say that she wants a 
Parent- Aide. 

• The Parent-Aide must report abuse or neglect, 
but is not there to prevent abuse or neglect. 

• Client confidentiality must be respected. The 
Parent- Aide and Social Worker must agree on what 
information about the client needs to be shared, and 
the client needs to know what level of confidential- 
ity she can expect. 

(From Project PREPARE, Lynn, Massachusetts) 



80 



ADOLESCENT PREGNANCY 



esteem." Elaborating on these themes were two re- 
spondents, who commented: 

• "It is essential that any program for teens 
recognize that while the problem generally pre- 
sents (itself) as a medical one, the medical 
aspect of teen pregnancy is only a small part of 
the overall picture, and if some of the other 
aspects such as economics, education, and 
emotional needs are not addressed, the medical 
care may be compromised." (TOPPS; Teen- 
Obstetrical Perinatal Parenting Services, Lit- 
tle Rock, Arkansas) 

• "I feel the program has been successful due to 
the determination of the nurse educator to 
reach these girls and the fact that she is a car- 
ing person... Also continuity with eachgirlplus 
flexibility are stressed, and the program is 
brought to them." (Adolescent Pregnancy Pro- 
gram, West Ridge, Pennsylvania) 

Several programs also suggested reaching the teen 
mothers early in their pregnancies and working with 
their parents and the baby's father. A number of pro- 
grams suggest including outreach services "since 
mothers with infants tend to isolate themselves" and 
following up once a teen has indicated interest in 
assistance. 

Other comments: 

• "Whether the program is designed for preg- 
nant teens or primary prevention of teen preg- 
nancy, the services need to address the broad 
adolescent developmental issues." (Chicago 
Comprehensive Care Center, Chicago, Illinois) 

• "Make sure parents of teens are involved in 
early stages of programming." (Parents and 
Teens Together, Philadelphia, Pennsylvania) 

• "Schools and community agencies and or- 
ganizations need feedback regarding the pro- 
gram and school-age parents. This can be 
accomplished by distribution of yearly pro- 
gram statistics and follow-up studies via advi- 
sory board members. Follow-up studies also 
increase community awareness of teenage 
pregnancy and the need for such services to this 
population." (Char-Em Alternative Program 
for School-Age Parents, Charlevoix, Texas) 

• Do not label an in-school clinic a pregnancy 
project. "This turns off many teens who may 
drop in for counseling before they become preg- 
nant." (Providence Ambulatory Health Care 
Foundation, Providence, Rhode Island) 

• Use the girl's school attendance and school 
adjustment as ways to identify those in need of 
intervention. "Otherwise, the teens in need do 
not seek out help." (Chicago Comprehensive 
Care Center, Chicago, Illinois) 



• "Know the community and the resources as 
well as the cultural background; know the 
background of the group you work with; walk 
through the material you will use. When this 
has been done, the program has worked well; 
when not, it has been a disaster." (Tools for 
Teen Programs, New York, New York) 

• "Contacting referral services has been the 
greatest help in getting these young women in 
the program. They really need a big push." (It's 
A New Life Teen Pregnancy Program, Apple- 
ton, Wisconsin) 

• "A primary dilemma has been in achieving 
acceptance in the schools. The basic problem 
was timing. In order to cultivate the population 
of school personnel who will be making the 
ultimate decision to incorporate such programs 
in the on-going school program, planning 
must begin early. Groundwork must be es- 
tablished and allies found within the school 
board. (National Board YWCA, New York, 
New York) 

• "Establish trust with patients through in- 
dividual sessions with a health educator at the 
time of first contact, if possible. This increases 
compliance." (SaludNew Horizons Adolescent 
Clinic, Fort Lupton, Colorado) 

• "The school is costly and is always in danger 
of closing due to reductions in State funds for 
education. I would advise that commitment to 
the effort to educate pregnant students should 
be sought at every level of government or from 
other funding sources." (Health Promotion/ 
Disease Prevention Program, St. Louis, Mis- 
souri) 

• "Although we cannot impose our personal 
morals, we can suggest they consider not only 
their parents' and church's teachings but their 
own responsibility to self and the effect another 
child has on their family and budget; that 
everyone is a worthwhile person with the 
potential to be somebody and to achieve any 
desired goal with sincere effort. Everybody is 
important in his or her own way. There is 
something good in the future with work and 
training." (Adolescent Health, Education, 
Jackson, Mississippi) 

Finally, one program recommended "a bit of luck and a 
good sense of humor." 



DDD 



81 



RESOURCES 



13 

Resources 



THE HEALTHY MOTHERS, HEALTHY 
BABIES COALITION - WHAT IS IT? 

The Healthy Mothers, Healthy Babies Coalition is an 
informal association of approximately 80 national pro- 
fessional, voluntary, and governmental organizations 
with a common interest in maternal and infant health. 
The purpose of the Coalition is to foster education 
efforts for pregnant women through collaborative ac- 
tivities and sharing of information and resources. Its 
goals are to: 

• PROMOTE public awareness and education in pre- 
ventive health habits for all pregnant women and 
their families 

• DEVELOP networks for sharing information among 
groups concerned about improving the health of 
mothers and babies 

• DISTRIBUTE public education materials on topics 
related to improving maternal and child health 

• ASSIST the development of State Healthy Mothers, 
Healthy Babies Coalitions 



WHY THE CAMPAIGN 

There are 16 other nations with a lower infant mortal- 
ity rate than the United States. The Coalition seeks to 
help reduce infant mortality and low birth weight in 
support of the Health Objectives for the Nation, 
through preventive health education for a broad pub- 
lic audience. 



WHAT ARE SOME SPECIFIC OBJECTIVES 

• To supply information that encourages healthy 
habits for pregnant women and women planning preg- 
nancy 

• To motivate pregnant women to protect their health 
through regular prenatal care and good nutrition 

• To increase women's understanding of specific 
health risks and the importance of taking responsibil- 
ity for healthy childbearing 



• To increase understanding among men of the sup- 
portive role they play in pregnancy and infant care 



WHAT HAS BEEN PRODUCED 

• A directory of educational materials on maternal 
and infant care facilities sharing of printed and 
audiovisual resources among members. It is now in 
its third edition. 

• A newsletter published to exchange news and in- 
formation from each quarterly Steering Committee 
meeting. 

• A curriculum guide (K through 12) on education for 
responsible childbearing. 

• A series of six posters and information cards for 
low-income pregnant women on nutrition, smoking, 
alcohol and drug use, breastfeeding and the im- 
portance of prenatal care. (English and Spanish) 

• "Outreach," an 8-minute slide-tape presentation 
describes the Coalition, what it is, what it is doing, and 
why communities should be involved. (Also available 
on videotape for sale and for loan) 

• A tabletop exhibit promoting the Coalition. (Avail- 
able on loan) 

• Two market research reports summarizing sources 
of health information for low-income women and their 
media habits. 

• A networking handbook to help communities start a 
Coalition chapter. 

• A modular television production to enable a local 
station to host easily a 30-minute segment on 
"Healthy Mothers, Healthy Babies." (Available on 
loan) 

• The mass media campaign, produced by the New 
York State Health Department (television, radio, 
print materials), to help State Coalitions begin public 
awareness activities. 



82 



RESOURCES 



WHAT ELSE IS BEING DONE 

Coalition projects are developed by Subcommittees 
addressing priority areas. These Subcommittees in- 
clude: motivation of low-income women, breastfeed- 
ing, substance use during pregnancy, genetic screen- 
ing, oral health, injury prevention, adolescent preg- 
nancy. Each subcommittee is producing new 
Coalition-sponsored educational materials and pro- 
grams; the low-income subcommittee was responsible 
for this compendium. In addition, standing sub- 
committees on research and development, policy, and 
networking direct Coalition activities. 



HOW CAN I BECOME INVOLVED 

The National Coalition is actively encouraging the 
establishment and maintenance of Healthy Mothers, 



Healthy Babies Coalitions in States and communities. 
More than 40 States are currently involved. If you are 
interested in working with a Coalition in your area, 
contact one of the following: 



• the national office of a National Coalition member 
organization (see list in this chapter); 

• the State or local office of an affiliated Coalition 
organization; 

• the individual State 'contact' (see list in this 
chapter); 

• the Executive Secretariat, National Coalition, 600 
Maryland Avenue, S.W., Suite 300E, Washington, 
D.C. 20024, for information about how to start a Coali- 
tion. 



NATIONAL COALITION 
MEMBERS 

•Indicates Steering Committee Member 

• Mary Beth Berkoff 

* ACCIDENT PREVENTION 
REHABILITATION INSTITUTE 
345 E. Superior Street 
Chicago, IL 60611 

(312) 649-2820 

• Rae Grad 

* ALLIANCE FOR PERINATAL 
RESEARCH & SERVICES, INC. 
P.O. Box 6358 

Alexandria, VA 22306 
(703) 765-6300 

• Charlotte Krebs 

* AMERICAN ACADEMY 
OF FAMILY PHYSICIANS 

1740 West 92nd St. 
Kansas City, MO 64114 
(816) 333-9700 

•Tom Solmon 
AMERICAN ACADEMY 
OF PEDIATRIC DENTISTRY 

837 South Main 
Greenville, MS 38701 
(601) 335-4596 

•Virginia Z. Kucera 

* AMERICAN ACADEMY 
OF PEDIATRICS 

141 Northwest Point Road 
Elk Grove Village, IL 60007 
(312) 228-5005 



•Elaine Petrucelli 

* AMERICAN ASSOCIATION 
FOR AUTOMOTIVE MEDICINE 
40 2nd Avenue 

Arlington Heights, IL 60005 
(312) 640-8440 

•Carolyn F. Gray 

* AMERICAN ASSOCIATION 
OF DENTAL SCHOOLS 
1619 Massachusetts Ave., NW 
4th Floor 

Washington, DC 20036 
(202) 667-9433 

•Xenia P. Montenegro 
AMERICAN ASSOCIATION 
OF SCHOOL 
ADMINISTRATORS 
1801 N. Moore Street 
Arlington, VA 22209 
(703) 528-0700 

•Leonard Hall 

* AMERICAN ASSOCIATION OF 
UNIVERSITY AFFILIATED 
PROGRAMS 

8605 Cameron Street, #406 
Silver Spring, MD 20910 
(301) 588-8252 

•Karen Ehrnman 
AMERICAN COLLEGE 
OF NURSE-MIDWIVES 
1522 K Street, NW 
Washington, DC 20005 
(202) 347-5445 



•Morton A. Lebow 

* AMERICAN COLLEGE OF 
OBSTETRICIANS & 
GYNECOLOGISTS 

600 Maryland Ave., S.W. 
Suite 300 E 
Washington, DC 20024 
(202) 638-5577 

•Lee L. Dogoloff 

* AMERICAN COUNCIL FOR 
DRUG EDUCATION 

5820 Hubbard Drive 
Rockville, MD 20852 
(301) 984-5700 

•M. Lisa Watson 

* AMERICAN DENTAL 
ASSOCIATION 

211 East Chicago Avenue 
Chicago, IL 60611 
(312) 440-2868 

•Ann Cole 

* AMERICAN DIETETIC 
ASSOCIATION 

430 N. Michigan Avenue 
Chicago, IL 60611 
(312) 280-5000 

•Julia Lockway 

* AMERICAN HOME 
ECONOMICS 
ASSOCIATION 

2010 Massachusetts Ave., NW 
Washington, DC 20036 
(202) 862-8300 



83 



RESOURCES 



• Elizabeth Lee 
♦AMERICAN HOSPITAL 
ASSOCIATION 

840 N. Lake Shore Drive 
Chicago, IL 60611 
(312) 280-6044 

• Sandra Willburn 
*AMERICAN INDIAN HEALTH 
CARE ASSOCIATION 

CA Urban Indian Health Council 
2422 Arden Way 
Sacramento, CA 95825 
(916) 920-0310 

•Karen Monaco 
♦AMERICAN LUNG 
ASSOCIATION 
1740 Broadway 
New York, NY 10019 
(212) 315-8717, 8723 

•Luz Porter 

♦AMERICAN NURSES' 
ASSOCIATION 
112 Poplar Drive 
Morgantown, WV 26550 
(304) 293-4297 

•Katherine McCarter 
♦AMERICAN PUBLIC HEALTH 
ASSOCIATION 
1015 15th Street, NW 
Washington, DC 20005 
(202) 789-5600 

• Carole Kauffman 
♦AMERICAN RED CROSS 
National Headquarters 
17th & D Streets, NW 
Washington, DC 20006 
(202) 639-3088 

• Susan Caskey 
♦AMERICAN SOCIETY 
OF DENTISTRY FOR 
CHILDREN 

221 E. Chicago Ave., Suite 920 
Chicago, IL 60611 
(312) 943-1244 

• Robert Moran 
♦AMERICAN SOCIETY FOR 
PSYCHOPROPHYLAXIS IN 
OBSTETRICS/LAMAZE, Inc. 
1840 Wilson Blvd. 

Suite 204 

Arlington, VA 22201 
(703) 524-7802 



•Audrey McMahon 
ASSOCIATION FOR CHILDREN 
WITH LEARNING 
DISABILITIES 
4156 Library Road 
Pittsburgh, PA 15234 
(412) 341-1515 

•Beverly H. Johnson 
ASSOCIATION FOR THE CARE 
OF CHILDREN'S HEALTH 
3615 Wisconsin Avenue, NW 
Washington, DC 20016 
(202) 244-1801 

• Linda Redman 
♦ASSOCIATION OF STATE 
AND 

TERRITORIAL HEALTH 

OFFICIALS 

VA State Health Dept. 

Division of Health Education 

109 Governor St., Rm. 100 

Richmond, VA 23219 

(804) 786-3551 

• Constance Barber 
♦AUXILIARY TO THE 
NATIONAL 

MEDICAL ASSOCIATION, INC. 

38 Longfellow Street, NW 
Washington, DC 20011 
(202) 829-3268 

• Paul M. Turner 

Dental Disease Prevention 

Activity 

♦CENTERS FOR DISEASE 

CONTROL 

1600 Clifton Road 

Room 345 

Atlanta, GA 30333 

(404) 329-1830 

•Ruth Gordner 
CHILD WELFARE LEAGUE 
OF AMERICA 

440 1st Street, NW 
Suite 520 

Washington, DC 20001 
(202) 638-2952 

•Kay Johnson 

♦CHILDREN'S DEFENSE FUND 
122 C St., NW 
Washington, DC 20001 

(202) 628-8787 



•Pamela Boyle 

♦COALITION ON SEXUALITY 
AND DISABILITY 
380 2nd Avenue 
New York, NY 10010 
(212) 677-6474 

• Steve Vigil 

FUTURE HOMEMAKERS 
OF AMERICA 
910 Association Drive 
Reston, VA 22091 
(703) 476-4900 

•Marion Slatin 

HEAD START-Administration 
of Children, Youth & Families 
5133 Donohoe Building 
400 6th Street, SW 
Washington, DC 20207 
(202) 755-7700 

•Mary Sullivan 

HEALTH CARE FINANCING 
ADMINISTRATION, DHHS, 
EPSDT 

6325 Security Boulevard 
Meadows East Building, Rm. 300 
Baltimore, MD 21207 
(301) 597-0451 

•Karin Caldwell 
HEALTH EDUCATION 
ASSOCIATES, 
INC. 

211 South Easton Road 
Glenside, PA 19038 
(215) 576-8071 

•Jean Smith 
INTERNATIONAL 
CHILDBIRTH 

EDUCATION ASSOCIATION, 
INC. 

634 E Street, NE 
Washington, DC 20002 
(202) 544-2899 

•Judy Good 
♦LA LECHE LEAGUE 
INTERNATIONAL 

1044 Hepplewhite 
Westerville, OH 43081 
(614) 891-4664 

•Mary Hughes 
♦MARCH OF DIMES BIRTH 
DEFECTS FOUNDATION 
1275 Mamaroneck Ave. 
White Plains, NY 10605 
(914) 428-7100 



84 



RESOURCES 



•Cheryl Grosso 

MILITARY FAMILY SUPPORT 
CENTER 

6501 Loisdale Court, Rm. 1107 
Springfield, VA 22150 
(703) 922-7671 

•Francine White 

^NATIONAL ASSOCIATION OF 
COMMUNITY HEALTH 
CENTERS, INC. 
1625 I Street, NW, Suite 420 
Washington, DC 20006 
(202) 833-9280 

•Grace Paris Starbird 
NATIONAL ASSOCIATION OF 
COUNTY HEALTH OFFICIALS 

440 First Street, NW 
Washington, DC 20001 
(202) 393-6226 

• David Stewart 
NATIONAL ASSOCIATION OF 
PARENTS & PROFESSIONALS 
FOR 

SAFE ALTERNATIVES IN 
CHILDBIRTH 
P.O. Box 267 
Marble Hill, MO 63764 
(314) 238-2010 

•Sallie Eissler 

NATIONAL ASSOCIATION OF 
PEDIATRIC NURSE 
ASSOCIATES & 
PRACTITIONERS 
6038 River Drive 
Lorton, VA 22079 
(703) 574-6898 

•Leila Whiting 
*NATIONAL ASSOCIATION 
OF SOCIAL WORKERS 
7981 Eastern Avenue 
Silver Spring, MD 20910 
(301) 565-0333 

•Lana Muraskin 
NATIONAL ASSOCIATION OF 
STATE BOARDS OF 
EDUCATION 

701 N. Fairfax St., Suite 340 
Alexandria, VA 22314 
(703) 684-4000 



• Mary Lynch Barnes 
*NATIONAL CATHOLIC 
EDUCATION 
ASSOCIATION 

1077 30th Street, NW, Ste. 100 
Washington, DC 20007 
(202) 293-5954 

•Phipps Y. Cohe 

*NATIONAL CENTER FOR THE 
PREVENTION OF SUDDEN 
INFANT 

DEATH SYNDROME 
330 N. Charles St. 
Baltimore, MD 21201 
(301) 547-0300 
(800) 638-SIDS 

•Emily Schrag 
*NATIONAL CENTER FOR 
CLINICAL INFANT PROGRAMS 
733 15th Street, NW 
Washington, DC 20005 
(202) 347-0308 

• Susan Durek 

NATIONAL CHILD NUTRITION 

PROJECT 

101 North 33rd Street 

Philadelphia, PA 19104 

(215) 662-1024 

• Helen Munoz 
*NATIONAL COALITION OF 
HISPANIC 

MENTAL HEALTH & HUMAN 
SERVICES 

ORGANIZATIONS (COSSMHO) 
1030 15th St., NW, Suite 1053 
Washington, DC 20005 
(202) 371-2100 

•William Pierce 
*NATIONAL COMMITTEE FOR 
ADOPTION 

2025 M Street, NW 
Suite 512 

Washington, DC 20036 
(202) 463-7559 

• Christine Lubinski 
^NATIONAL COUNCIL ON 
ALCOHOLISM 
Washington Representative 
1511 K St., NW, Suite 320 
Washington, DC 20005 
(202) 737-8122 



• Winifred Coleman 
^NATIONAL COUNCIL OF 
CATHOLIC WOMEN 

1312 Massachusetts Ave., NW 
Washington, DC 20005 
(202) 638-6050 

• Leslie Atkinson 
*NATIONAL DENTAL 
ASSOCIATION 

5506 Connecticut Ave., NW 
Suites 24-25 
Washington, DC 20015 
(202) 244-7555 

• Marilena Amoni 
^NATIONAL HIGHWAY 
TRAFFIC 

SAFETY ADMINISTRATION 
NTS-11, USDOT 
400 7th Street, SW 
Washington, DC 20590 
(202) 426-9294 

•Roselyn Epps, MD 
*NATIONAL MEDICAL 
ASSOCIATION 
Department of Pediatrics & 
Child Health 

Howard University Hospital 
2041 Georgia Avenue, NW 
Washington, DC 20060 
(202) 636-6974 

•Lynne Bounds 
^NATIONAL 
PARENT-TEACHERS 
ASSOCIATION 
1319 Corbett Lane 
Orlando, FL 32806 
(305) 898-4952 

• Sandra Butler Whyte 
*NATIONAL PERINATAL 
ASSOCIATION 

101 1/2 South Union Street 
Alexandria, VA 22314 
(703) 549-5523 

•Luba Djurdjinovic 
*NATIONAL SOCIETY OF 
GENETIC 

COUNSELORS, INC. 
710 O'Neil Building 
Binghamton, NY 13901 
(607) 723-9692 



85 



RESOURCES 



•Miles Vaughn 

NATIONAL URBAN LEAGUE, 
INC. 

500 East 62nd Street 
New York, NY 10021 
(212) 310-9134 

•Doris Haire 
^NATIONAL WOMEN'S 
HEALTH 
NETWORK 

224 7th Street, SE 
Washington, DC 20003 
(202) 543-9222 

•Sallye Brown 

*NURSES ASSOCIATION OF 
THE 

AMERICAN COLLEGE OF 
OBSTETRICIANS 
AND GYNECOLOGISTS 
Suite 200E 

600 Maryland Avenue, SW 
Washington, DC 20024 
(202) 638-0026 

• Louise Tyrer 
*PLANNED PARENTHOOD 
FEDERATION OF AMERICA 

810 7th Avenue 
New York, NY 10019 
(212) 541-7800 

• Richard Jones 

*SOCIETY FOR ADOLESCENT 
MEDICINE 

Adolescent Clinic-Georgetown 
University Hospital 
3800 Reservoir Road. NW 
Washington, DC 20007 
(202) 625-7383 



•Joanne Guthrie 
^SOCIETY FOR NUTRITION 
EDUCATION 
P.O. Box 27 

College Park, MD 20740 
(301) 454-5223 

• Col. Edith MacLachlan 
*THE SALVATION ARMY 
120 W. 14th Street 

New York, NY 10011 
(212) 620-4900 

• Mary Kay Sainsbury 
^TRIPLET CONNECTION 
590 Marigold Drive 
Fairfield, CA 94533 
(707) 427-2018 

•Edith Thomas 
*USDA, EXTENSION SERVICE 
EFNEP, 14th & Independence, 
SW 

Room 3451, South Building 
Washington, DC 20250 
(202) 447-3743 

• Jane Mims 

USDA, FOOD & NUTRITION 

SERVICE 

3101 Park Center Drive 

Room 11-0-3 

Alexandria, Va 22302 

(703) 756-3730 

• Jeanne M. Priester 
*USDA, SCIENCE AND 
EDUCATION 

14th & Independence Ave., SW 
Room 3443, South Building 
Washington, DC 20250 
(202) 447-2908 



•Elaine Bratic Arkin 
*US PUBLIC HEALTH 
SERVICE 

Room 725-H, HHH Building 
200 Independence Avenue, SW 
Washington, DC 20201 
(202) 245-3102 

•Martha Burt 
URBAN INSTITUTE 
2100 M Street, NW 
Washington, DC 20037 
(202) 223-1950 

•Susan L. Regnier 
*YMCA 

c/o You & Me Baby 
475 Cedar Street 
St. Paul, MN 55101 
(612) 292-4128 

•Dr. Janice Sola 
YWCA NATIONAL BOARD 
726 Broadway 
New York, NY 10003 
(212) 614-2700 



STATE COALITION 
CONTACT LIST 



For further information, please contact 

the Healthy Mothers, Healthy Babies National Coalition 

Attn: Lori Cooper. 



•ALABAMA 

Sharon Jordan 

Family Health Administration 
434 Monroe Street 
Montgomery, AL 36130-1701 
(205) 261-5095 



•ALASKA 

Joan Pelto 

Nutrition Services Manager 

Dept. of Health & Social Services 

Pouch H-06B 

Juneau, AK 99811 

(902) 465-3103 

•ARIZONA 

Laura Chenet 

HMHB Coordinator 

Arizona Department of Health 

Services, Bureau of Maternal 

and Child Health 
1740 West Adams Street 
Phoenix, Arizona 85007 
(602) 255-1875 



•ARKANSAS 

Sherry Walker 
Executive Director 
Arkansans for Reproductive 

Health 
Hall Building, Suite 304 
209 W. Capitol Avenue 
Little Rock, AR 72201 
(501) 372-5074 

•CALIFORNIA 

Frances Hornstein 
HMHB Coordinator 
2000 Center Street 
P.O. Box 1156 
Berkeley, CA 94704 
(415) 849-2229 



86 



RESOURCES 



-COLORADO 

Carolyn Kercheck 

Colorado Department of Health 

4210 E. 11th Avenue 

Denver, CO 80220 

(303) 331-8270 

•CONNECTICUT 

Bernice Hibbard 

and Muriel Yacavone, HMHB 
MCH Section 
CT Department of Health 

Services 

150 Washington Street 
Hartford, CT 06106 
(203) 566-3287 

'DISTRICT OF COLUMBIA 

Venera Busby 

D.C. Office of Maternal & Child 
Health 

1875 Connecticut Ave., N.W., 
Room 804 

Washington, D.C. 20009 
(202) 673-4551 

•FLORIDA 

Cathy Nell 

HMHB Coalition 

730 N.E. Waldo Road, Suite B 

Gainesville, FL 32601 

(904) 392-5667 

•GEORGIA 

Carolyn Hommel 

Food & Drug Administration 

Office of Consumer Affairs 

1010 West Peachtree St., N.W. 

Atlanta, GA 30309 

(404) 881-7355 

•GUAM 

Janine Nesset 

Administrator 

Nutrition Health Services 

P.O. Box 2816 

Agana, GU 96910 

011-671 734-3343 

•HAWAII 

Janet Huff 

Program Coordinator 

March of Dimes 

600 Kapiolani Blvd., Room 208 

Honolulu, HI 96813 

(808) 536-1045 



IDAHO 

Mary Lou Beck 
Nutrition Consultant 
Bureau of Child Health 
Department of Health & Welfare 
State House Mail 
450 West State Street 
Boise, ID 83720 
(208) 334-4148 

IOWA 

Joyce Borgmeyer 

MCH Program Administrator 

Iowa State Department of Health 

Lucas Building, 3rd Floor 

Des Moines, IA 50319 

(515) 281-5787 

ILLINOIS 

Elsie Baukol, M.D. 

Parents Too Soon/ Adolescent 

Pregnancy Program, 
Illinois Department of 

Public Health, 
535 W. Jefferson 
Springfield, IL 62761 
(217) 782-5945 

•INDIANA 

Gwen Rossell 

Indiana State Department of 

Health 
Maternal and Child Health 
1330 W. Michigan Street 
Indianapolis, IN 46206 
(317) 633-0100 

•KANSAS 

Sara Bonam 

Bureau of Family Health 

Kansas Department of Health 

and Environment 
Forbes Field 
Topeka, KS 66620 
(913) 862-9360 Ext. 452 

•MAINE 

John C. Serrage, M.D. 

or Mollie W. Jenckes 
Division of Maternal and Child 

Health 
State House Station 11 
Augusta, ME 04333 
(207) 289-3311 



•MARYLAND 

Donna Petersen 

Department of Maternal & Child 

Health 
Johns Hopkins University 
615 N. Wolfe St., Rm. 7503 
Baltimore, MD 21205 
(301) 955-6836 

•MASSACHUSETTS 

Robin Blatt 
Education Coordinator 
Massachusetts Department of 
Public Health 

150 Tremont Street, 3rd Floor 
Boston, MA 02111 
(617) 492-1487 

•MICHIGAN 

Dan McGarry 
PAC/Alcona Health Center 
177 N. Barlow Road 
Lincoln, MI 48742 
(517) 736-8157 or 8158 

•MINNESOTA 

Diedre Richards, RN 
Minnesota Department of Health 
717 S.E. Delaware Street 
Minneapolis, MN 55440 
(612) 623-5594 

•MISSISSIPPI 

Christy Montgomery 

Coalition for Mothers and Babies 

P.O. Box 4981 

Jackson, MS 39216 

(601) 981-2397 

•MISSOURI 

Patricia Raasch 

Perinatal Education Coordinator 

Missouri Division of Health/ 

Department of Social Services 
Post Office Box 570 
Jefferson City, MO 65102 
(314) 751-4353 

•MONTANA 

Donald Espelin, M.D. 
Director, IPO Project 
Department of Health 
Cogswell Building 
Helena, MT 59620 
(406) 444-4743 



87 



RESOURCES 



•NEBRASKA 

Bob Nelson, M.D. 
Department of Pediatrics 
University of Nebraska Medical 

Center 
42nd and Dewey Avenue 
Omaha, NE 68105 
(402) 559-7295 

•NEVADA 

Milton Gan 

Executive Director 

Greater Nevada Health Systems 

Agency 
308 N. Curry Street #205 
Carson City, Nevada 89701 
(702) 883-7863 

•NEW HAMPSHIRE 

Chris Shannon, M.S., R.D. 
Nutrition Consultant 
Bureau of Maternal and Child 

Health 
New Hampshire Division of 

Public Health Service 
6 Hazen Drive 
Concord, NH 03301-6527 
(603) 271-4541 

•NEW JERSEY 

Margaret Luhn 

N.J. Department of Health 

120 S. Stockton Street 

CN364 

Trenton, N.J. 08625 

(609) 292-5616 

•NEW MEXICO 

Linda Lonsdale 

Maternal and Child Health Head 

New Mexico Health & 

Environment Department 
P.O. Box 968 
Santa Fe, New Mexico 
87504-0968 
(505) 989-0030 Ext. 516 

-NEW YORK 

Pat Casaw 

New York State Health Dept. 

Room 890, Corning Tower Bldg., 

28th Floor, Empire State Plaza 

Albany, NY 12237 

(518) 474-2543 



•NORTH CAROLINA 

Laura Grant, MSW 
Department of Pediatrics 
Bowman Gray School 

of Medicine 
300 South Hawthorne 
Winston-Salem, NC 27103 
(919) 748-4431 

Phyllis Gray 

Health Education 

MCH Section 

NC Division of Health Svc. 

P.O. Box 2091 

Raleigh, NC 27602 

(919) 733-7791 

•OKLAHOMA 

Eva Carter 

Oklahoma Institute for Child 
Advocacy 

614 NE 4th Street, Suite 219 
Oklahoma City, OK 73104 
(405) 236-2789 

'OHIO 

James Quilty, M.D. / Wendy 

Shannon 

Chief, Division of MCH 

Ohio Department of Health 

246 N. High Street, Box 118 

Columbus, OH 43216 

(614) 466-3263/466-4716 

•OREGON 

Joanne Dehoff 
Program Coordinator 
March of Dimes 
702 Woodlark Building 
813 S.W. Adler Street 
Portland, OR 97205 
(503) 222-9434 

■PUERTO RICO 

Jaime Rivera Dueno, M.D. 

Secretary of Health 

Call Box 70184 

San Juan, Puerto Rico 00936 

(809) 751-8394 

•RHODE ISLAND 

David Gagnon 
Women & Infants Hospital 
50 Maude Street 
Providence, RI 02908 
(401) 274-1100 Ext. 1110 



•SOUTH CAROLINA 

Libby Hoyle 

Extension Home Economist 

246 Plant & Animal Science 

Building 
Clemson University 
Clemson, SC 29634 

(803) 656-3268 

• SOUTH DAKOTA 

Carol Hosmer 
March of Dimes 
327 Broadway, Room 6 
Yankton, SD 57078 
(605) 665-8084 

•TENNESSEE 

Susie Baird 

TN Department of Public Health 
100 Ninth Avenue North 
Nashville, TN 37219-5405 
(615) 741-7305 

•TEXAS 

Pam Felker 

Texas Department of Health 

Public Health Promotion 
1100 W. 49th Street 
Austin, TX 78756 
(512) 458-7405 

•UTAH 

Gail Evans 

Maternal Health Consultant 

Maternal & Infant Health 

Bureau 
Utah Dept. of Health 
44 Medical Drive 
Salt Lake City, UT 84113 
(801) 533-4084 

Ramona Woodhead 
2477 Skyline Drive 
Salt Lake City, UT 84108 

(801) 582-3194 

•VERMONT 

Claire LeFrancois, RN, MPH 
MCH Consultant 
Vermont Department of Health 
1193 North Avenue, P.O. Box 70 
Burlington, VT 05402 

(802) 863-7330 

•VIRGINIA 

Diane Bailey 
667 Seaford Road 
Seaford, VA 23692 

(804) 898-1550 



88 



RESOURCES 



-WASHINGTON 
Melinda McMahan 
Program Specialist 
WA Maternal & Child Health 

Program 
MS LC 12A 
Olympia, WA 98504 
(206) 753-6153 

•WEST VIRGINIA 
Sam Folio 

Division of Health Education 
WV State Department of Health 
1800 Washington St., Room 535 
Charleston, WV 25312 
(304) 348-0644 



'WISCONSIN 

Anita Grand, R.N., C.N.M. 
Division of Health 
Bureau of Community Health 
and Prevention 
1 West Wilson Street 
Madison, WI 53701 
(608) 266-9823 



Patrice Mocny Onheiber 
Healthy Birth Program 

Coordinator 
Wisconsin Div. of Health 
P.O. Box 309 
Madison, WI 53701 
(608) 267-9300 



SELECTED FEDERAL HEALTH 
INFORMATION CLEARINGHOUSES 

The Federal Government operates a number of 
clearinghouses, most of which focus on a particular 
topic, such as maternal and child health. Their ser- 
vices vary but may include publications, referrals, or 
answers to consumer inquiries. 

Food and Nutrition Information Center, National 
Agricultural Library Bldg., Rm. 304, Beltsville, MD 
20705. (301) 344-3719. Serves the information needs 
of professionals interested in nutrition education, food 
service management, and food technology. Acquires 
and lends books, journal articles, and audiovisual 
materials related to these areas. 

National Clearinghouse for Alcohol Information, 
P.O. Box 2345, Rockville, MD 20852. (301) 468-2600. 
Gathers and disseminates current information on 
alcohol-related subjects. Responds to requests from 
the public, as well as from health professionals. Dis- 
tributes a variety of publications on alcohol abuse. 

Clearinghouse on Child Abuse and Neglect, P.O. 
Box 1182, Washington, DC 22013. (301) 251-5157. 
Collects, processes, and disseminates information on 
child abuse and neglect. Responds to requests from the 
general public and professionals. 

National Clearinghouse for Drug Abuse Informa- 
tion, P.O. Box 416, Kensington, MD 20795. (301) 443- 
6500. Collects and disseminates information on drug 
abuse. Produces information materials on drugs, drug 
abuse, and prevention. Provides information to both 
consumers and health professionals. 

National Clearinghouse for Family Planning In- 
formation, P.O. Box 12921, Arlington, VA 22209. 
(703) 558-7932. Collects family planning materials, 
provides referrals to other information centers, and 
distributes and produces materials. Primary audience 
is Federally funded family planning clinics. 



National Clearinghouse for Maternal and Child 
Health, 38th and R Sts. NW, Washington, DC 20057. 
(202) 625-8410. Provides information and publica- 
tions on maternal and child health to consumers and 
health professionals. 

National Clearinghouse for Primary Care, 8201 
Greensboro Dr., Suite 600, McLean, VA 22102. (703) 
821-8955. Provides information services to support 
the planning, development, and delivery of ambula- 
tory health care to urban and rural areas where short- 
ages of medical personnel and services exist. Although 
the Clearinghouse will respond to public inquiries, its 
primary audience is health care providers who work in 
community health centers. 

National Health Information Clearinghouse, P.O. 

Box 1133, Washington, DC 20013-1133. (703) 522- 
0870 (in Virginia); (800) 336-4797. Assists the public 
in locating health information by identifying health 
information resources and providing an inquiry and 
referral service. Health questions are referred to 
appropriate health resources that respond directly to 
inquiries. 

Office on Smoking and Health, Technical Informa- 
tion Ctr., Park Bldg., Rm. 1-10, 5600 Fishers Ln., 
Rockville, MD 20857. (301) 443-1690. Offers 
bibliographic and reference services to researchers 
and others, and publishes and distributes a number of 
publications related to smoking and health. 

Project Share (Human Services), P.O. Box 2309, 
Rockville, MD 20852. (301) 231-9539. Provides 
reference and referral services designed to improve 
and manage human services by emphasizing the inte- 
gration of those services at the delivery level. There is 
a charge for publications. 

Further information on the work of the Healthy 
Mothers, Healthy Babies Coalition, may be obtained 
by writing to: Executive Secretariat, Healthy 
Mothers, Healthy Babies, 600 Maryland Ave., SW, 
Ste. 300E, Washington, DC 20024. 



89 



RESOURCES 



RESOURCE BOOKS AND DIRECTORIES 

Asian Language Materials - Annotates and gives 
ordering information for materials on infertility, con- 
traception, childbirth, and other reproductive health 
topics in many Indochinese languages. 
Order from: National Clearinghouse for Family Plan- 
ning Information, P.O. Box 2225, Rockville, MD 
20852. Single copy free. 

Asian/Pacific Islander Mental Health Promotion 
Resource Directory - Provides an extensive an- 
notated listing of print and audiovisual materials ar- 
ranged by age groups and ethnic target population 
with sections for speakers of Chinese, English, 
Japanese, Korean, Philippino, and Samoan. Produced 
by Asian Community Mental Health Services for the 
California Department of Mental Health. Order No. 
7540-956-1020-7. 53 pp. (1981). Single copy, $6.00. 
Order from: Asian Community Mental Health Ser- 
vices, Publications Unit, P.O. Box 1015, North High- 
lands, CA 95660. 

Bibliography: Selected Health Materials in Span- 
ish - Lists selected health materials in Spanish, ar- 
ranged by subject. Sources include businesses, the 
Federal and State Governments, and voluntary organ- 
izations. Also lists other resources, including curric- 
ulum materials. 58 pp. (1985) 

Order from: COSSMHO, National Coalition of His- 
panic Mental Health and Human Service Organiza- 
tions, 1030 15th St., NW, Suite. 1053, Washington, DC 
20005. Single copy free while supplies list. 

Compendium of Resource Materials on Adoles- 
cent Health - Provides a manual for practitioners and 
administrators faced with the challenge of meeting 
the health needs of adolescent populations. The Office 
of Maternal and Child Health, Bureau of Community 
Health Services, sponsored a 3-year series of regional 
workshops on adolescent health from 1977-1980. This 
compendium represents materials developed by work- 
shop faculty members in six areas: physical growth 
and development, psychosocial growth and develop- 
ment, nutrition, sexuality, health concerns, and ad- 
ministrative issues. Each section contains summary 
presentations, outlines, articles, bibliographies, and 
sample forms. 183 pp. (1981) Single copy free. 
Order from: National Maternal and Child Health 
Clearinghouse, 38th and R Sts. NW, Washington, DC 
20057. (202) 6325-8410. 

Contraception Slide Chart - Slide chart with easy 
comparison between 10 forms of contraception. Shows 
advantages, disadvantages, effectiveness rates, costs 
and risks of each method. Single copy at no cost; send 
business size self-addressed, stamped envelope. 
Order from: Office of Public Information, American 
College of Obstetricians and Gynecologists, 600 Mary- 
land Ave. SW, Ste. 300E, Washington, DC 20024. 



Designing Your Family Planning Education Pro- 
gram - Offers practical "how-to" information for de- 
signing a new education service or improving an exist- 
ing one. Defines steps for the design of staff develop- 
ment programs in a family planning setting. The 
guide contains some helpful charts and a checklist for 
assisting staff members in assessing their training 
needs. 90 pp. (1980) Single copy free. 
Order from: National Clearinghouse for Primary 
Care, 8201 Greensboro Dr., Suite 600, McLean, VA 
22102. (703) 821-8955. 

Exposure to Print and Electronic Media: Women 
Age 18-34 - Prepared for the US Public Health Service 
by Chilton Research Services; reports on the reading 
and media habits of young women, especially low-SES 
women. 50 pp. (1982) Single copy free. 
Order from: National Health Information Clearing- 
house, P.O. Box 1133, Washington, DC 20013-1133. 

Family Planning in Primary Care Centers - Pre- 
sents a guide to developing or improving family plan- 
ning programs. Suggestions are offered for approaches 
to implementing these services, with emphasis given 
to prevention activities. 28 pp. (1980) Single copy free. 
Order from: National Clearinghouse for Primary 
Care, 8201 Greensboro Dr., Suite 600, McLean, VA 
22102. (703) 821-8955. 

Healthguide on Marketing - Discusses the concept 
of marketing health promotion programs and provides 
practical ideas and resources for further information. 
2 pp. (1985) Single copy. 

Order from: National Association of Community 
Health Centers, 1625 I St., NW, Washington, DC 
Improving Family Planning Services for Teen- 
agers - Discusses effective strategies for delivering 
family planning services to teenagers. This report of 
an evaluation study of family planning services con- 
tains recommendations for improving program 
effectiveness. 129 pp. (1976) Single copy free. 
Order from: National Clearinghouse for Family Plan- 
ning Information, P.O. Box 12921, Arlington, VA 
22209. 

Indochinese Health Information - Lists organiza- 
tions and publications available to health educators 
for aiding Indochinese people in adapting to a new 
society. 4 pp. (1984) Single copy free. 
Order from: National Health Information Clearing- 
house, P.O. Box 1133, Washington, DC 20013-1133. 
Kou Man Nou Ye? An English-Haitian Creole 
Guide for Medical Personnel - Serves as a phrase 
book and glossary for English-speaking medical per- 
sonnel who care for Creole-speaking Haitians. Writ- 
ten by Martin P. Kantrowitz, Antonio Mondragon, 
and William Lord Coleman, this guide includes sec- 
tions on almost two dozen medical problems from "Af- 
ter a Major Accident" to "Family Planning." There are 



90 



RESOURCES 



also sections on common and everyday phrases and an 
alphabetical glossary of basic Haitian vocabulary 
words. This is a translation of Que Paso? An English- 
Spanish Guide for Medical Personnel. 75 pp. (1984) 
Single copy free. 

Order from: National Clearinghouse for Primary 
Care, 8201 Greensboro Dr., Suite 600, McLean, VA 
22102. (703) 821-8955. 

Media for Safety and Health - Lists, with complete 
annotations on content and intended audience, and 
information on format, rental, and sale, current films, 
videotapes, and slide sets produced or sponsored by the 
Federal Government for the general public and health 
professionals. Topics include child health, safety, and 
nutrition. 39 pp. (1984) Single copy free. 
Order from: National Audiovisual Center, Washing- 
ton, DC 20409. 

Nutrition Education Resource Guide: An An- 
notated Bibliography of Educational Materials 
for the WIC and CSF Programs - Offers a guide to 
evaluated print and audiovisual nutrition education 
materials appropriate for women, infants, and chil- 
dren. Materials are classified according to targeted 
audience and address the following areas: pregnancy, 
breastfeeding, infant feeding, preschool children, and 
general nutrition and meal planning. Each item listed 
is described and evaluated, and information is pro- 
vided on format, reading level, availability, and cost. 
Stock No. 001-000-04307-2. 146 pp. (1982) Single copy, 
$6.00. 

Order from: Superintendent of Documents, US Gov- 
ernment Printing Office, Washington, DC 20402. 

Parent Held Child Health Record ■ Not a publica- 
tion, but a form for families that move frequently. 
Provides space to record immunizations, dates and 
results of medical exams, dental records, and growth 
assessments. Instructions for using the compact 
health record are provided in English and Spanish. 
Folder. (1985) Single copy free. 
Order from: Interstate Research Associates, 1555 Wil- 
son Blvd., Suite. 700, Rosslyn, VA 22209. 

A Portable Prenatal Record - A form for women 
who relocate during prenatal care. Offers space for 
recording a brief medical history, problems/risk fac- 
tors, lab tests, health education topics to be discussed 
with the patient, and a list of appointments. In- 
structions for the patient are provided in English and 
Spanish. Folder. (1984) Single copy free. 
Order from: National Clearinghouse for Primary 
Care, 8201 Greensboro Dr., Suite 600, McLean, VA 
22102. (703) 821-8955. 

Preventing Fetal Alcohol Effects: A Practical 
Guide for OB/GYN Physicians and Nurses - Offers 
information to help health care professionals identify 
patients at risk for the health problems associated 



with alcohol consumption during pregnancy. 20 pp. 
(1983) Single copy free. 

Order from: National Clearinghouse for Alcohol In- 
formation, P.O. Box 2345, Rockville, MD 20852. 

Preventing Low Birthweight ■ Reviews the im- 
plications of low birthweight for child health, its 
causes and associated risks, and recent trends. This 
comprehensive report, prepared by the Institute of 
Medicine, recommends a variety of interventions, in- 
cluding measures to take before pregnancy, methods 
to identify high-risk women, improved accessibility of 
prenatal care, a public information program, and re- 
search. A shorter summary is also available. Full re- 
port, 284 pp. (1984) Single copy, $17.50. Summary, 41 
pp. (1985) Single copy, $3.00. Discounts are available 
on bulk orders. 

Order from: National Academy Press, 2102 Constitu- 
tion Ave., NW, Washington, DC 20418. 

Promoting Nutrition Through Education: A Re- 
source Guide to the Nutrition Education and 
Training Program - Describes nutrition education 
materials developed by State education agencies, uni- 
versities, and school districts participating in the 
Federal Nutrition Education and Training Program. 
Some of the materials are specific to geographic areas, 
but the content, format, or approach may be useful to 
others developing similar resources. Contact informa- 
tion is given for many of the materials; all are avail- 
able on loan from the Food and Nutrition Center. The 
second section of the guide contains a bibliography of 
journal articles concerning NET. Stock No. 001-000- 
4436-2. 268 pp. (1984) Single copy, $7.50. 
Order from: Superintendent of Documents, US Gov- 
ernment Printing Office, Washington, DC 20402. 

Que Paso? An English-Spanish Guide for Medical 
Personnel - Serves as a Spanish glossary and phrase 
book for health care workers. This guide was written 
for individuals with little or no Spanish-language 
background who work in a clinic, emergency room, or 
physician's office. It features the proper way to ask 
common questions in various medical situations and 
includes probable answers. A basic vocabulary list is 
also included. 69 pp. (1978) Single copy free. 
Order from: National Clearinghouse for Primary 
Care, 8201 Greensboro Dr., Suite 600, McLean, VA 
22102. (703) 821-8955. 

Reducing Perinatal Risks in Rural Areas: A Pro- 
viders Manual - Describes models of regionalized 
perinatal care and integrated perinatal services; pro- 
vides assessment and action tools for improving peri- 
natal care in one's community; summarizes special 
clinical considerations in rural obstetric and perinatal 
care. This reference manual is targeted to rural health 
care providers. 75 pp. (Available in 1986, price to be 
determined). 



91 



RESOURCES 



Order from: National Rural Health Care Association, 
2220 Holmes, Kansas City, MO 64108. 

Removing Cultural and Ethnic Barriers to Health 
Care - Presents proceedings of a national conference 
of social workers in leadership positions from across 
the country whose work focuses on maternal and child 
health. The purpose of the conference, held in Chapel 
Hill, was "to explore the variables that impact on the 
delivery of health care to persons of diverse ethnic and 
cultural identities." 265 pp. (1979) Single copy free. 
Order from: National Maternal and Child Health 
Clearinghouse, 3520 Prospect St., NW, Suite 1, Wash- 
ington, DC 20057. 

Report of the Surgeon General's Workshop on 
Breastfeeding and Human Lactation - Reports on a 
workshop held to assess the current status of 
breastfeeding in the United States and to develop 
strategies to facilitate breastfeeding. This workshop 
brought health professionals together to discuss the 
physiology and process of human lactation, the com- 
position of human milk, trends in breastfeeding, 
socioanthropologic factors, and successful approaches 
for promoting breastfeeding. 93 pp. (1984) Single copy 
free. 

Order from: National Clearinghouse for Maternal and 
Child Health, 38th and R Sts. NW, Washington, DC 
20057 

Spanish-Language Health Information - Provides 
a bibliography of resources and a directory of organi- 
zations focusing on health information available in 
Spanish. 7 pp. (1985) Single copy free. 
Order from: National Health Information Clearing- 
house, P.O. Box 1133, Washington, DC 20013-1133. 

Strategies for Promoting Health for Specific Pop- 
ulations - Examines the health promotion needs, 
priorities, and concerns of minorities. This report is 
based on meetings held with representatives of five 
specific populations: Asian, Black, Hispanic Amer- 
icans, elderly Americans, and Native Americans. Par- 
ticipants recommended ways to implement national 
health promotion objectives for each group, specifying 
priorities, needs for technical assistance and direct 
services, grants, manpower development, and in- 
formation dissemination. DHHS Pub. No. (PHS) 81- 
50169. 53 pp. (1981) Single copy free. 
Order from: National Health Information Clearing- 
house, P.O. Box 1133, Washington, DC 20013-1133. 



APPENDIX 



A 



Survey 
Instrument 



DDD 



92 



RESOURCES 



/> 



HEALTHY MOTHERS/HEALTHY BABIES COALITION SURVEY 
METHODS AND MATERIALS FOR LOW-INCOME WOMEN 



The purpose of this survey is to discover unique and effective educational or awareness programs and materials that are 
designed to improve the health and well-being of low-income women and their babies. All replies will be analyzed, compiled, 
and distributed in order that others may learn from successful programs and approaches. 



PROGRAM NAME: 
CONTACT: 



MAILING ADDRESS: 



PHONE NUMBER: 



_□ Check if you would like to receive a copy of the finished compendium. 



. TYPE OF CLIENT GROUP TARGETED (check all that 
apply) 

1. Income level: 

□ Low-income only □ Some low-income 

2. Reading level: 

□ Illiterate 

□ 1st - 3rd grade 
D 4th - 6th grade 

□ 7th - 9th grade 

□ 1 0th grade and above 

3. Age group(s): 

□ Teenager (17 and under) 

□ Young adult (18 -29) 

□ Older adult (30 and over) 

4. Ethnic group(s): 

D Black 

□ White 

□ Hispanic 

□ Native American 

□ Asian/Pacific Islander 

□ Other (specify) 

5. Language(s) used in program/materials: 

□ English only 

□ Bilingual (specify language(s)) 
D Other (specify) 

6. Stage(s) to which program is directed: 

□ Pre-pregnancy 

□ Pregnancy 

□ Post-partum 

□ Newborn 

□ Infancy 

7. Special problems addressed: 

□ Substance abuse 

□ Inadequate nutrition 

D Sexually transmitted diseases 

□ Other (specify) 



B. PROGRAM CHARACTERISTICS (check all that apply) 

1. Length of time program has operated: 

□ Less than 1 year 

□ 1-3 years 

□ More than 3 years 

2. Program site: 

□ Health care facility 

□ Home 

□ School 

□ Workplace 

□ Church/synagogue 

□ Public facility/community building 

□ Other (specify) 

3. Funding sources: 

□ Federal Government 

□ State/local government 

□ Business 

□ Foundation 

□ Agency/organization budget 

□ Client contribution 

□ Other (specify) 

4. Other agencies cooperating in your program: 

□ Church 

□ Hospital 

□ Business 

□ Government 

□ Community organization 

□ Clinic 

□ School/college 

□ Other (describe) 

5. Research activities conducted for your program: 

□ Market research 

□ Community needs assessment 

□ Program evaluation 

□ Other (specify) 



93 



RESOURCES 



C. MATERIALS 

1 Specify promotional or educational materials used (check all that apply): 

□ Film □ Filmstrip 

□ Videocassette □ Brochure 

□ Slide-tape presentation □ Fact Sheet 

□ Slides only D Poster 



D PSA (Public Service Announcement) 

□ TV 

□ Radio 

□ Participant Workbook 

□ Other (specify) 



2. Were materials produced or developed by your program/agency? 

□ no □ yes If yes, give title(s) and type of materials and tell whether copies are available (attach separate 

page if necessary). 



3. Were materials prepared by or obtained from another source? 

D no □ yes If yes, specify title(s) and source(s) of materials you would recommend to others (attach separate 

page if necessary). 



4. Are there materials currently unavailable that you would like to see developed? Describe subjects and formats. 



D. NARRATIVE (Attach separate page if necessary) 

1. Program Description: List the program's goals and objectives. Describe as fully as possible what the program does, 
how it operates, and whom it serves, focusing on any "unique" features or approaches directed to low-income women. 



2. Evidence of Success: Highlight the achievements of the program in terms of the program's goals and objectives. Cite 
specific accomplishments and methods of evaluation; give examples. Include any pertinent statistics or rates of success, such 
as a decrease in maternal and infant complications. 



3. Comments: What advice would you give to others who may be interested in replicating your program? Why did it work 
or not work? (Be as specific as possible.) 



Please attach copies of promotional materials, curriculum outlines, educational materials, needs 
assessments, or market research or other reports that were produced especially for your program. 



/ 



healthy mothers, healthy babies 



Mail the completed survey form to: 

Compendium 

Healthy Mothers/Healthy Babies 

P.O. Box 47 

Washington, DC 20044 



94 



RESOURCES 



MEDICAID ELIGIBILITY FOR PREGNANT 
WOMEN/EPSDT OPTIONS 

Recent Congressional actions expanded the eligibility 
of pregnant women for Medicaid services. 



APPENDIX 



B 



EPSDT 



Mandatory Eligibles 

The Deficit Reduction Act of 1984 (DEFRA) (P.L. 98- 
369) required States to provide Medicaid services to 
those pregnant women (from the time of medical ver- 
ification of pregnancy) who could meet income and 
resource requirements of the Aid to Families with 
Dependent Children (AFDC) program and who: 

1. were pregnant for the first time and would be 
eligible for AFDC if the child were born, including 
those pregnant women in an AFDC -unemployed- 
parent-type family whether or not the State has 
elected to provide case assistance to this group; OR 

2. were in two-parent families where the principal 
breadwinner was unemployed. 

Coverage was effective on October 1, 1984, except 
where a State applied to the Secretary of Health and 
Human Services for approval of delay in implementa- 
tion because its legislature must pass a law to amend 
the State Medicaid plan to conform to Federal legisla- 
tion. 

As of March 1, 1985, all but six States are believed to 
have implemented these two provisions. 



Optional Eligibles 

The Tax Equity and Fiscal Responsibility Act of 1982 

(TEFRA) (P.L. 97-248) permitted States to provide 
Medicaid services to pregnant women who were not 
eligible for AFDC cash benefits, but who nonetheless 
met the income and resource requirements of the 
AFDC program. (Prior to TEFRA, this option was 
available as coverage for "unborn" children.) 

As of March 1, 1985, 22 States provided this optional 
categorically needy coverage to pregnant women, the 
largest group of whom are in low-income two-parent 
families. 

The Omnibus Budget Reconciliation Act of 1981 

(OBRA) (P.L. 97-35) required States which cover any 
medically needy recipients to provide, at a minimum, 
prenatal and delivery services for pregnant women. 

As of March 1, 1985, 35 States provided medically 
needy coverage to pregnant women. However, in eight 
States, the service package for medically needy preg- 
nant women differed from that offered to the categor- 
ically eligible pregnant women. 



95 



RESOURCES 



MEDICAID COVERAGE OF PRENATAL CARE 

States have considerable flexibility to design and fi- 
nance prenatal care benefit packages by using exist- 
ing Medicaid authority for coverage of preventive care 
services. 

The Medicaid program interprets preventive care as 
including those services that (1) involve direct patient 
care; and (2) are for the express purpose of diagnosing, 
treating, or preventing (or minimizing the adverse 
effects of) illness, injury, or other impairments to an 
individual's physical or mental health. 

Many Medicaid-covered services have preventive ele- 
ments. Some are targeted specifically to children and 
pregnant women. For example, any State program for 
the "medically needy" must at a minimum, provide 
pregnant women with prenatal care and delivery ser- 
vices. Medicaid comparability requirements further 
assure that those services provided to the medically 
needy must also be provided to the categorically 
needy. 

In addition, the Early and Periodic Screening, Di- 
agnosis, and Treatment (EPSDT) program may be 
used to provide pre-pregnancy risk education, family 
planning, and services to pregnant teenagers. 

Beyond covering preventive care as an integral part of 
other Medicaid services, States can cover preventive 
care as a separate optional benefit. Regulations at 42 
CFR 440.130(c) define such services as: 

"...services provided by a physician or other licensed 
practitioner of the healing arts within the scope of 
his practice under State law to — 

1. Prevent disease, disability and other 
health conditions or their progression; 

2. Prolong life; and 

3. Promote physical and mental health 
and efficiency. 

The services must involve direct patient care; they 
must also be directly concerned with the patient's en- 
vironment; and they must also be directly and pri- 
marily concerned with the recipient's health needs (as 
opposed to services aimed primarily at addressing 
basic life needs which affect health only indirectly). 

Using EPSDT Authority to Expand Benefits and 
Improve Health Care Delivery 

Pregnancy testing can be made a regular part of the 
EPSDT screening examination and it can be author- 
ized for reimbursement at frequent intervals. Girls 
found to be pregnant can be given extensive medical, 
health, and emotional support services that can be 
billed under EPSDT. Such services might include 
health, psychosocial, and nutritional assessments; 
counseling on the hazards of tobacco, drug, and alcohol 



use; pregnancy-related vitamins; childbirth educa- 
tion; and parent training. Family planning services 
could be provided as well. In communities with high 
rates of teen pregnancy, the State could launch an 
aggressive outreach campaign to bring adolescent 
girls into the EPSDT program, and it could contract 
with providers qualified to conduct pregnancy testing 
(perhaps in the schools) and deliver a special prenatal 
care package to improve pregnancy outcome. 

EPSDT also may be used to finance increased benefits 
for at-risk infants. The maternity ward is an ideal 
place for States to conduct EPSDT outreach. At the 
mother's request, the State could ensure that hospital 
and physician providers bill the infant's initial health 
examination as the first EPSDT screen. Extended hos- 
pital stays for premature and other sick newborns 
then could be covered under EPSDT. The same is true 
for any necessary medical or surgical procedure. In- 
fant therapies to improve psychosocial functioning 
could be authorized as well. In addition, the EPSDT 
program could provide reimbursement for screening 
examinations additional to those in the State's per- 
iodicity schedule. 

Several States have begun to use the EPSDT program 
as part of an overall strategy to reduce infant mortal- 
ity. In California, counties are preparing perinatal 
care plans that include EPSDT services. In Con- 
necticut, the EPSDT manager is a member of the peri- 
natal task force that sets and monitors quality stan- 
dards for hospital services to newborns. 

Minnesota relies on EPSDT to help finance four high 
school clinics located in the inner city area of St. Paul. 
The initial purpose of the clinics was to provide preg- 
nancy testing and prenatal care. They since have ex- 
panded to offer comprehensive health services to the 
entire student population. Pediatric care for infants 
now is available as well. Obstetrical services, screen- 
ing examinations, family planning services, health 
education, and well baby care all are provided at the 
school sites. Diagnostic and treatment services are 
delivered on an outpatient or inpatient basis at the St. 
Paul Ramsey Hospital. Tests and screening examina- 
tions for Medicaid-eligible children are billed to 
EPSDT; other services, however, are charged to the 
regular Medicaid program. 



DDD 



96 



RESOURCES 



APPENDIX 



C 



NHeLP 



NHeLP SERVICES/LEGAL STRATEGIES 

The National Health Law Program (NHeLP) is a 
Legal Services Corporation-funded national support 
center that provides technical assistance and training 
to lawyers and advocates across the country. Assis- 
tance ranges from answering questions about specific 
health programs to more detailed research and anal- 
ysis, to helping with litigation efforts. NHeLP also 
prepares resource materials including a health law 
newsletter, detailed guides, and articles on specific 
health programs/problems. 

In January 1982, NHeLP began a Maternity Care/ 
Infant Mortality Project in response to requests from 
legal services lawyers for assistance involving preg- 
nant women seeking prenatal and hospital care. Since 
that time, the project has gathered and developed ex- 
tensive legal materials and files on Medicaid, Hill- 
Burton hospitals' responsibilities, the Maternal and 
Child Health Block Grant, State and local legislative 
provisions for health care, and other related laws per- 
taining to poor women. This data collection effort pro- 
duced Birth Rights: An Advocate's Guide to Ending 
Infant Mortality (August 1983).* Also available is a 
basic flyer for low-income women entitled "How to Get 
Care for Your Pregnancy and Birth." 

One goal of the Maternity Care/Infant Mortality 
Project is to examine obstacles to access to maternity 
care service — both health services and other support 
services necessary to ensure a healthy pregnancy and 
a healthy baby. A second goal is to help local and 
national advocates devise strategies that remedy 
these obstacles. The third goal is to serve as a legal 
resource to those who need assistance to understand 
existing health legislation and how to best use the law 
to help women obtain maternity care. 

Specific areas that the Maternity Care/Infant Mortal- 
ity Project are working on include: 



Medicaid Provider Advocacy 

Under current law, physicians are not required to see 
Medicaid patients. According to NHeLP research, ob- 
stetricians are more reluctant to see Medicaid patients 
than physicians in any other specialty. Seeking to 
increase the number of physicians and alternative 
providers who will care for Medicaid patients is a 
viable strategy. Many studies have found that an in- 
crease in Medicaid fees will significantly increase the 
number of physicians participating and the extent of 
participation. If increasing fees is chosen as a strategy, 
advocacy groups can attempt to negotiate a fee in- 
crease in their State, or failing that, bring litigation 
under a number of legal theories. 



♦Available from National Health Law Program, Inc., c/o Kathleen Stoll, 2025 M Street 
N.W., Suite 400, Washington, DC, 20036. 



97 



RESOURCES 



A large body of research shows that simplifying and 
expediting the reimbursement process also will in- 
crease the willingness of physicians to treat Medi- 
caid patients. Again, the problem can be 
approached through administrative advocacy with 
the State or through litigation. Encouraging the 
adoption of simplified claim forms or the adoption of 
a universal claim for Medicaid, Medicare, Blue 
Cross, and private insurers is one avenue. Other 
avenues may be pursued around "red tape" 
reimbursement problems such as the institution of 
case management with capitated payment for ser- 
vices rather than fee-for-service payment. (It is im- 
portant that safeguards to ensure adequate services 
and quality of care to Medicaid recipients are built 
into case management systems.) 

Those working on provider participation expansion 
can find potential remedies in the Medicaid Act. For 
example, under 42 U.S.C. Sl396(a)(19), States are re- 
quired to use methods of determining eligibility that 
are not unnecessarily complicated or time-consuming. 
States cannot administer the provisions for services in 
a way which "adversely affects the availability of the 
care to be provided." 



A State can take steps to increase provider partici- 
pation in Medicaid through its regulatory powers. For 
example, a State licensing board can require all physi- 
cians to treat Medicaid patients under certain circum- 
stances such as emergencies. A State might also re- 
quire that graduates of its State-supported medical 
schools accept a certain number of Medicaid patients 
for a certain number of years following graduation. 
States can also take steps to expand the participation 
of alternative providers, such as nurse-midwives, by 
reimbursing them at the same rate as physicians pro- 
viding the same services. The Maternity Care/Infant 
Mortality Project can provide technical assistance 
with these legislative initiatives. 

The Federal Equal Credit Opportunity Act and im- 
plementing Regulation B can be a tool in increasing 
access to care for Medicaid patients. The Act and 
Regulation B prohibit discrimination in any aspect of 
a credit transaction on the ground that any part of the 
applicant's income derives from a public assistance 
program. Any person who regularly extends credit is 
covered by the Act. Thus any doctor or hospital that 
regularly provides services without requiring full pay- 
ment at the time services are rendered, by billing 
patients later or accepting reimbursement from pri- 
vate insurance companies, is a "creditor." As a credi- 
tor, the doctor or hospital cannot discriminate against 
persons applying for services because they are Medi- 
caid recipients. 



Hill-Burton Hospital Obligations 

NHeLP has prepared a 108-page Advocate's Guide to 
Hill-Burton Uncompensated and Community Ser- 
vices. The manual contains an explanation and anal- 
ysis of the new Federal regulations under the Hill- 
Burton Act, as well as strategies for aggressive 
enforcement.* 

The Hill-Burton Act is a Federal law that gave public 
funds to hospitals and nursing homes to build and 
remodel their facilities. In return for this money, these 
hospitals and nursing homes promised to set aside a 
certain amount of free or reduced-cost care to low- 
income people for 20 years. This promise is called the 
facility's "free care" obligation. Hill-Burton hospitals 
also promised to make services available to all persons 
living in their services area. This "community service" 
obligation must be provided indefinitely. A Hill- 
Burton hospital must take any necessary steps to en- 
sure that admission to and services of the facility are 
available to Medicaid patients without discrimina- 
tion. If some of the physicians in a particular depart- 
ment of a hospital will not treat Medicaid patients, 
so that some Medicaid patients are excluded from a 
service, the hospital is in violation of the community 
service obligation. 

The Hill-Burton Act can be used as leverage to provide 
prenatal care. For example, one rural community 
group used information negotiations with a hospital to 
convince administrators to require their obstetricians 
to accept Medicaid as a condition of receiving staff 
privileges. All of the obstetricians within the commu- 
nity belonged to one medical practice and comprised 
the entire ob-gyn section of the only local hospital. 
Because none of the obstetricians would accept Medi- 
caid patients, the hospital was out of compliance with 
the community service obligation. Similarly, publicity 
and a thorough knowledge of the Hill-Burton Act 
regulations helped community groups in Plymouth, 
Massachusetts, convince a hospital that its staff could 
not ignore their obligation to the poor. The result there 
was a new clinic providing prenatal care and other 
ob-gyn services to all women, with Medicaid patients 
treated free and other patients allowed to pay in small 
installments. 

The Maternity Care/Infant Mortality Project can help 
citizens plan strategies to improve provider partici- 
pation in low-income maternity care and learn how 
the Hill-Burton Act has been successfully used in 
other communities. 

Alternative Providers Issues 

The Maternity Care/Infant Mortality Project is inter- 
ested in expanding the scope of midwives' practice 
through broader State regulations. Certified nurse- 
midwives face obstacles preventing them from practic- 
ing such as restrictions of privileges at hospitals, in- 
ability to find physician back-up, and increased pre- 
miums for the physicians willing to provide medical 

•Available from the National Clearinghouse for Legal Services. 500 N. Michigan Avenue, 
Suite 940, Chicago, Illinois 60611 



98 



RESOURCES 



back-up to midwives from their malpractice insurance 
carriers. Yet midwifery practice is an excellent way to 
provide care to low-risk women, that is, women who 
have normal, healthy pregnancies. 

OTHER STRATEGIES 

The list of possible legal avenues for expansion of 
prenatal and maternity services with which the 
NHeLP Maternity Care/Infant Mortality Project can 
help groups includes: 

• State emergency care statutes which clearly 
define "emergency" to include labor. These sta- 
tutes require all hospital emergency rooms to 
provide services to "emergency" patients with- 
out regard to the patients' ability to pay. 

• State medical malpractice legislative reforms 
which fairly balance the legal rights of low- 
income women against the need to have reason- 
ably priced professional liability insurance 
available to obstetric care providers. 

• State expansion of the content of prenatal 
care programs for low -income women so that 
all medically necessary care is provided. 
Federal legislation currently under considera- 
tion will give States the option to provide other 
services (e.g., health education, prenatal health 
counseling, other preventive services) to preg- 
nant women under their Medicaid program 
even if such services are not available to other 
classes of Medicaid recipients. It should be 
remembered that even without this Federal 
legislation, States can choose to fund expanded 
services without Medicaid matching money. 
(See Appendix B: EPSDT Services) 

• State expansion of Title V Maternal and 
Child Health Block Grants programs targeted 
at low -income, high-risk prenatal and delivery 
services. 

• Community Health Centers have traditional- 
ly served a large percentage of low -income 
women. The project could assist a group in- 
vestigating how to start a private prenatal and/ 
or birthing center, and help research new ways 
to fund the center. 

The NHeLP Maternity Care/Infant Mortality Project 
is willing to provide legal assistance for those promot- 
ing healthy mothers and healthy babies and those 
pursuing avenues in their State and local com- 
munities to help low-income women. Contact NHeLP 
at: 

(Main Office) 

2639 South La Cienega Blvd 
Los Angeles, CA 90034 
(213) 204-6010 

or 

(Branch Office) 
2025 M Street, NW, Suite 400 
Washington, DC 20036 
(202) 887-5310 




99 



RESOURCES 



B. Norman Barwin MD 

President 

Planned Parenthood 

770 Broadview Ave Ste B-1 

Ottawa K2A 3Z3 

2c 3c 4a 6d 7bhmu 



Pub Hlth Nurse 

Lissa Bl iesath PHN 

PO Box 316 

Ft Yukon AK 99740 

2bc 3c 4bd* 6d 7bhm 



Parent Chi Id Ctr 

Betty Harrold 

Dir 

2101 West Daniel Payne Dr 

Birmingham AL 35214 

2bc 3c 4a 6c 7kh 



Early Prenatal Ed Curriculum 

AK Dept Hlth Svcs 

Carolyn Aoyama 

525 E 4th Ave 

Anchorage AK 99501 

2c 3c 4abd 6bc 7ihkmu 



AK Counc on Prev of Alcohol 
and Drug Abuse 
Claudia Shanley Brunner 
7521 Old Seward Hwy Ste A 
Anchorage AK 99502 
2d 3c 4abcde*f 6d 7m 



WIC Prog--Anchorage 

Dept Hlth/Environ Protection 

Beverly K Jones RD 

Pouch 6-650 

Anchorage AK 99502 

3c 4abc*de 6d 7nhjm 



PHS AK Native Med Ctr 

MCH Ofc 

Gai 1 Stewart 

US Pub Hlth Svc 

Box 7-741 

Anchorage AK 99510 

2d 3c 4d 6bc 7ghm 



AL Area Native Hlth Svc 

Nutrition Sect 

Elizabeth D Nobmann 

Chief 

PO Box 7-741 

Anchorage AK 99510 

2bc 3c 4d 6d 7gh 



Yukon-Kuskokwim Parent-Child 

Prog 

Sharon Hodgins 

Superv 

PO Box 925 

Bethel AK 99559 

2c 3c 4d* 6c 7khm 



WIC Prog--Fairbanks Hlth Ctr 
Sharon Bel 1 
800 Airport Way 
Fairbanks AK 99701 
2bc 3b 4abcde 6bc 7nhm 



State Pub Hlth 

Pub Hlth Nurse 

Box 64 

Galeva AK 99741 

2c 3b 4d 6b 7ihm 



WIC Prog--Mani la Assn 

Virginia Flanders 

PO Box 256 

Kotzbue AK 99752 

2ab 3b 4d* 6bc 7nhm 



WIC Prog 

Norton Sound Hlth Corp 

Amel ia Di ckerson 

Box 966 

Nome AK 99762 

2d 3c 4bcdef 6bc 7nhm 



Nutrition Svcs (WIC) 

AL Dept Hlth/Social Svcs 

Joan M Pel to 

Pouch H-06B 

Juneau AK 99811 

2d 3c 4bc*d*e 6bc 7ch 



ESPDT/AK Dept Hlth 
Section of Nursing 
Jane Mi 1 ler 
Prog Coord 
Pouch H-06 E 
Juneau AK 
2d 3c 4abd* 6d 7e 



& Social Svcs 



99811 



Publ ic Hlth CI inic 

Pam Ford 

PHN 

State of AK 

Box 379 

Wrangell AK 99929 

2d 3c 4bd 6b 7bhmu 



Med Ctr East Fami ly 
Practice Ctr 

John L. Buckingham MD MPH 
7833 2nd Ave S 
Birmingham AL 35206 
2bc 3ab 4ab 6d 7bhmuv 



A Westside Adolescent 
Resource and Educ Proj 
Katherine Helm-Hinton 
Mande L Whattey Hlth Ctr 
2731 - 32nd Ave 
Tuscalossa AL 35401 
2d 3c 4a 6d 7ahijmu 



W Al Hlth Svcs/Prenatal 

Prog & Infant Hlth 

Nancy Garnand 

Prog Instructor 

607 Wi 1 son Ave 

Eutau AL 35462 

2d 3c 4ab 6d 7chmtu 



WIC Prog--Winston Cty 

Deborah G Pruitt 

PO Box 57 

Double Springs AL 35553 

2d 3ab 4ab 6bc 7nhm 



WIC Prog--Marion Cty 
Marion Cty Hlth Dept 
PO Box 103 

Hamilton AL 35570 
2d 3c 4abde 6bc 7nh 



Southern Rural Hlth Care 

Consortium 

Margaret Cunningham 

Exec Dir 

lklkl 

PO Drawer N 

Red Bay AL 35582 

2ab 3b 4ab 6d 71 hm 



WIC Prog--De Kalb Cty 

Ethel Smith RN 

PO Box 347 

Fort Payne AL 35967 

2d 3c 4abc 6d 7nhm 



Autauga Cty Hlth Dept 
PO Box G 

Prattville AL 36067 
2c 3c 4ab 6d 7chjmu 



100 



RESOURCES 



St Margarets Hosp Nurse 

Midwifery Prog 

Sister Mary Kay 

303 S Ripley St 4800 

Montgomery AL 361 04 

2d 3c 4abcde*f 6bc 7chuv 



Bur of Dental HI th 

AL Dept Pub Hlth 

Naseeb L Shory DDS MPH 

Dir 

43 1 * Monroe St 

Montgomery AL 36130 

6cd 7q 



AL Dept Pub Hlth 

Child Restraint Prog 

James McVay 

Dir 

Bur Primary Prev 

206 St Ofc Bldg 

Montgomery AL 36130 

2c 3c 4abcdef 6bc 7k 



AL Dept of Pub Hlth 

-Fami ly Hlth Admin 

Sharon V Jordan 

434 Monroe St 

Montgomery AL 36130-1701 

2c 3c 4ab 6d 7chmu 



Montgomery Cty Hlth Dept 

Mary Hosselwonder 

PO Box 4008 

Montgomery AL 36195-3601 

2c 3c 4ab 6d 7chu 



Prenatal Classes 

Jacksonvi 1 le Hosp 

Box 229 

Jacksonville AL 36265-3399 

2c 3ab 4abe 6b 7ihu 



Houston Cty Hlth Dept 

Maternity Clinic 

PO Box 2087 

Dothan AL 36302 

2c 3c 4ab 6b 7chjmu 



ACCESS 

Betty Peters 

PO Box 1153 

Pine Bluff AR 71613-1153 

2bcd 3a 4abc 6d 7aku 



AR Hwy Safety Prog 
Angela Powers 
1 Capitol Mall 4B-215 
Little Rock AR 72201 
2ab 3ab 4ab 6bc 7k 



Florence Crittenton Home Svcs 

Beverly J Hoi comb MD 

3600 W 11th 

Little Rock AR 72204 

2ab 3ab 4abc*de 6bc 7ahmu 



TOPPS--Teen Obstetrical 

Perinatal-Parenting Svcs 

Lee Lee Doyle MD 

Univ of AK OB/GYN Dept 

Slot 518 UAMS 

Little Rock AR 72205 

2c 3a 4ab 6bc 7abhimuv 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d • All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC Prog--Houston Cty 

Sue H Garner RN 

PO Drawer 2087 

Dothan AL 36302 

2d 3c 4abc*e* 6d 7nh 



Pregnancy Plan 
Univ of S AL 
Micki Cabanios 
2451 Fi 1 1 ingim St 
Mobile AL 36617 
2d 3c 4ab 6b 7ik 



Family-Oriented Primary 

Hlth Care CI inic 

John R Wi 1 1 iamson 

Mobile Cty Hlth Dept 

PO Box 2867 

Mobile AL 36652 

2d 3c 4abe 6d 7chmu 



Families on the Grow 

Irene K Lee, MD 

Univ of Arkansas 

Box 4007 

Pine Bluff AR 71601 

2bc 3a 4abe 6ab 7ahkmu 



Infant CPR (Cardiopulmonary 

Resuscitation) 

Deborah D Carmen RN BSN 

Vol Dir Nursing/Hlth Care Svcs 

American Red Cross/Pulaski Cty 

401 S Monroe 

Little Rock AR 72205 

2c 3c 4abcde 6d 7kv 



Hlthy Beginnings 

James McHaney 

AR Dept of Hlth 

4815 W Markham 

Little Rock AR 72205-3867 

2d 3c 4abc 6bc 7bhmu 



Mississippi Cty Nurse Midwife 

Prog 

PO Box 1047 

Blytheville AR 72315 

2d 3c 4ab 6bc 7ihu 



101 



RESOURCES 



Hlthy Beginnings 

Kathey Boeckmann RN 

Inservice Spec 

111 Cook St 

Forrest City AR 72396 

2c 3ab 4ab 6d 7fhmu 



AZ Dept Hlth Svcs 

Ofc Hlth Educ 

Donna Shomer 

1740 W Adams 

Phoenix AZ 85007 

2b 3c 4abcdef 6d 7chm 



WIC/Perinatal Proj--Pina1 

Cty Hlth Dept 

Darlene Jordon RN 

PO Box 807 

Florence AZ 85232 

2d 3c 4abc* 6bc 7nh 



High Risk of Teenage Pregnancy 

Tena Crowe 

NE Arkansas March of Dimes 

Box 7062 

Jonesboro AR 72403 

2c 3a 4ab 6a 7ahu 



D Musgrove RN 

Mansfield Pub Sch 

PO Box 417 

Mansfield AR 72944 

2c 3a 4b 6ab 7a 



WIC/Maternity-Child Hlth 

AK Dept Hlth--Frankl in Cty 

Bertha Myers RN 

Frankl in Co Hlth Unit 

207 N 4th St 

Ozark AR 72949 

2c 3ab 4b 6bc 7nh 



Maternal/Chi Id Hlth 

Pub Hlth Div Amer Somoa Govt 

Diana Pi 1 itati 

Pub Div Dept Hlth Svcs 

Pago Pago AS 96799 

2bc 3ab 4e* 6d 7jhu 



E AZ Mental Hlth Ctr 

Anne Penney 

PO Box 2426 

Opelika AZ 36803-2426 

2b 3ab 4ab 6c 7k 



Maricopa Cty Hlth Dept 
Title V Nutrition Svcs 
Shirley Strember MS RD 
1825 E Roosevelt 
Phoenix AZ 85006 
2b 3c 4abc*de 6d 7chm 



Maricopa Cty WIC Prog 

Steve Buckles RD 

WIC Admin 

Maricopa Cty Hlth Dept 

1825 E Roosevelt 

Phoenix AZ 85006 

2d 3c 4ab*cd* 6bc 7n 



Nurse-Midwifery Dept Phoenix 

Mem Hosp 

Ann Marie Faxel CNM 

Dir HMS 

1201 S 7th Ave 

Phoenix AZ 85007 

2c 3ab 4abc* 6bc 7fh 



Phoenix Indian Med Ctr — Comm 

Hlth 

Mary Beth Skupien DCHM 

US Pub Hlth Svc 

4212 N 16th St 

Phoenix AZ 85016 

2c 3c 4g* 6bc 7gmu 



Phoenix Area Indian Hlth Svc 

N Buroon Attico MD 

Indian Hlth Svc 

3738 N 16th St 

Phoenix AZ 85016 

2c 3c 4d 6d 7ghmu 



Inter-Tribal Counc of AZ/WIC 

Mary Hoskin 

Nutr i t ionist/Admin 

124 W Thomas Ste 201 

Phoenix AZ 8501 8 

2d 3c 4d* 6d 7nhm 



Casa Linda Lodge--Cathol i c 

Fami 1 y & Comm Svcs 

Annemarie A Lopez 

Exec Dir 

1825 W Northern 

Phoenix AZ 85021 

2bc 3ab 4abcd 6b 7ihv 



Chicanos Por la Causa/Via 

De Amistad 

Lisa Large MSW 

March of Dimes Found 

1402 S Central 

Phoenix AZ 85034 

2c 3ab 4abc*d 6bc 7bhkmuv 



Marana Comm Clinic 
Chr i s Wi nters 
13644 N Sandario Rd 
Marana AZ 85238 
2d 3c 4abc*d 6d 7bhkmu 



Scottsdale Mem Hosp 
V Rafferty RN 
Dir Maternal/Child Hlth 
7400 E Osborn 
Scottsdale AZ 85251 
2c 3c 4abc*def 6bc 7b 



WIC Prog--Salt River 

Pima-Maricopa Indian 

Hazel M Thomas 

Salt River Hlth Svcs 

Rt 1 Box 216 

Scottsdale AZ 85256 

2c 3c 4d 6d 7nhm 



WIC Prog--Avondale Primary Care 

Ctr 

Carol Heinz 

Marion Cty Dept Hlth Svcs 

501 N 8th St 

Avondale AZ 85323 

2b 3c 4abc*d 6bc 7nh 

Dept Econ Secur i ty--Admin 

for Children Youth Families 

Laurie White 

AZ Dept HH Svcs 

350 W 16th St Ste 232 

Yuma AZ 85364 

2d 3c 4abc*def 6d 7chmpu 

Yuma Cty Hlth Dept 

Perinatal Proj 

Sally Lewis RN MPH 

Dir Nursing 

201 2nd Ave 

Yuma AZ 85364 

2d 3c 4abc* 6bc 7ih 



Catholic Comm Svcs in Yumg 

Phyl 1 is Rowe 

Child Welfare Worker 

301 S 2nd Ave Ste 2 

Yuma AZ 85364 

2d 3c 4abc*def 6d 7ihmu 



102 



RESOURCES 



WIC Prog--Val1ey Hlth Ctr 

Nancy L Meister RD 

WIC Dir 

164 4th Ave 

Yuma AZ 85364 

2d 3c 4abc* 6bc 7nhm 



Santa Cruz Cty Hlth Dept 

Diabetis Millitus Screening Prog 

Lora Zeinun PN 

200 La Castel lana Dr 

Nogales AZ 85621 

2c 3c 4c* 6b 7iht 



Fam Ping/Child Hlth Coord Proj 

Coconino Dept Pub Hlth 

Sonya Moore RN 

2500 N Fort Valley RD 

Flagstaff AZ 86001 

3c 4abc*de 6d 7khu 



Greenlee Cty Hlth Dept 

Rochel le Figueroa 

PO Box 936 

Clifton AZ 85533 

2c 3c 4bc* 6d 7nh 



Catholic Comm Svcs (Santa Cruz) 

Franic Vargas MSW 

475 Grand Ave 

Nogales AZ 85621 

2d 3c 4bc*d 6d 7bmv 



Santa Cruz Cty Prenatal Prog 
Rosa A Garcia RN 
200 La Castel lana Dr 
Nogales AZ 85621 
2c 3c 4bc* 6d 7chijmtu 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d • Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage! s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d- All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n • WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Indian Hlth Svc 

Sel Is Svc Unit 

Felix D Hurtado MD MPH 

US Pub Hlth Svc 

Box 568 

Sells AZ 85634 

2b 3c 4d* 6d 7ghmu 



Pima Cty Hlth Dept 

Perinatal Prog 

Carol M Lyons 

175 W 1 1 vington 

Tucson AZ 85714 

2d 3c 4abc*de 6bc 7chmu 



Improved Pregnancy Outcome Prog 

High Risk Maternity Prog 

Mary Ellen Kenivorthey RNP 

Apache Cty Hlth Dept 

P0 Box 697 

St Johns AZ 85936 

2bc 3c 4bc 6bc 7ihm 



Prenatal Svcs 

Apache Cty Hlth Dept 

Shelee T Seymour 

4 Week Svcs-Coordinated Ext 

Agent-Home Ec 

PO Box 369 

St Johns AZ 85936 

2c 3c 4bcd 6bc 7ihmv 



Child Abuse Prevention Proj 

AZ Dept Econ Security 

Cathy Maxwel 1 

PO Box 339 

St Johns AZ 85936 

2bc 3ab 4bc* 6d 7khmp 

WIC Prog — White Mtn Apache Tribe 

Cornel ia Hof tman 

Box 18 

Whiteriver AZ 85941 

2c 3c 4d* 6d 7nhm 



Childbirth Ed 

Coconina Cty Dept Pub Hlth 

Laura Laughran 

2500 N Fort Valley Rd 

Flagstaff AZ 86001 

3c 4abcd 6bc 7khio 



WIC — Coconino Cty Dept 

Pub Hlth 

Shei la Walsh 

Pub Hlth Nutritionist 

2500 N Fort Valley Rd 

Flagstaff AZ 86001 

2d 3c 4abc*def 6d 7nhmo 



Keams Canyon DHHS Hosp 

Eric Henley MD 

US Pub Hlth Svc 

Keams Canyon AZ 86034 

2c 3c 4d 6d 7g 



Womens Hlth Care Emphasis 

Rose Rowan RN 

OB/GYN Nurse Practitioner 

PO Box 888 

Keams Canyon AZ 86034 

2bc 3c 4d 6ab 7ihu 



Indian Hosp 

US Pub Hlth Svc 

Tuba Cy AZ 86045-2927 

2d 3c 4d* 6d 7ghmu 



Navajo Area Indian Hlth Svc 

B Carol Mil 1 i gan CNM 

Acting MCH Consultant 

US Pub Hlth Svc 

PO Box G 

Window Rock AZ 86515 

2d 3c 4d* 6d 7ght 



WIC Prog--Navajo Nation 

Kenneth Souza MPH RD 

Chief Nutritionist 

PO Drawer 1390 

Window Rock AZ 86515 

2bc 3c 4bd* 6d 7nh 



Portland Hlth Care Ctr 

Judyth Vait 

Dir 

PO Box 88 N Main St 

Portland Ak 71663 

2bc 4abc* 6ab 7ihu 



103 



RESOURCES 



Sat ilia Area Substance 
Abuse Prog 
Frances E Fields 
1305 Pendergast St 
Waycross CA 31501 
2d 3c 4ab 6b 7m 



Inter-Agy Anti -Smoking Prog 

with Pregnant Women 

Rob Simmons 

American Lung Assn/LA Cty 

PO Box 36929 

Los Angeles CA 90036-0926 

2b 3c 4abc 6bc 7m 



San Fernando Valley 
Child Guidance Clinic 
Marlene Zepeda PHD 
9650 Zelzah Ave 
Northridge CA 91325 
2b 3c 4abc* 6c 7kp 



WIC Prog— LA 

Pam McCandless 

WIC Coord 

Nutrition Sect Box 6O63O 

New Orleans CA 70130 

2c 3c 4abc*e* 6bc 7nhm 



Baby 6 Tracking 

Arthur Lisbin MD 

7601 E Imperial Hwy 

Bldg 307 Rancho Los Amigos Hosp 

Downey CA 90242 

2ab 3c 4abc*def 6c 7k 



Conejo Comm Svcs Ctr 

Sharron Baird 

Admin 

166 N Moorpark Rd #301 

Thousand Oaks CA 91360 

2c 3c 4abc 6d 7bu 



WIC Prog 

Watts Hlth Found 

Valerie E Coachman-Moore MPH RD 

WIC Dir 

10300 S Compton Ave 

Los Angeles CA 90002 

2bc 3c 6d 7n 



Comm Perinatal Direct Svcs 

or Maternal/Chi Id Hlth 

Rosyland Frazier 

Watts Hlth Found 

10300 Compton Ave 

Los Angeles CA 90002 

2d 3c 4ac 6bc 7bhjmu 



Prenatal Enhancement Prog 

H Claude Hudson Comp Hlth Ctr 

Phyl 1 is Paxton 

2829 S Grand 

Los Angeles CA 90007 

2d 3c 4abc*e 6bc 7ihm 



THE Clinic for Women 

Anita L Gonzalez 

3860 W Martin Luther King Blvd 

Los Angeles CA 90008 

2d 3c 4abce* 6d 7ihm 



Crittenton Ctr for Young 
Women and Infants 
Nancy Tallerino LCSW 
234 E Ave 33 

Los Angeles CA 9003 1 
2bc 3a 4abcde 6d 7bhmpu 



Salvation Army Booth Mem Ctr 

Joyce Johnstone 

2670 Griffin Ave 

Los Angeles CA 90031 

2c 3c 4abc* 6d 7abhmuv 



Youth and Family Ctr 
Gayle Nathanson 
Exec Dir 
Lawndale YMCA 
14512 Larch Ave 
Lawndale CA 90260 
2d 3a 4abc*de 6d 7ahmu 



Los Alamitos Med Ctr 

Marjorie Pyle 

3751 Katella Ave 

Los Alamitos CA 90720 

2c 3b 4abc*e 6d 7ihs 



Long Beach Family Ping 

Mindy Perkinson 

101 Atlantic Ave 

Long Beach CA 90802 

2d 3c 4abc*e 6ac 7ju 



Prenatal Care Utilization Proj 

Long Beach Pub Hlth Dept 

Lynn McKibbin RN 

Proj Dir 

2655 Pine St 

Long Beach CA 90806 

2bc 3c 4abc* 6bc 7ih 



WIC Prog--Long Beach 

Iris Schutz 

2125 Santa Fe Ave 

Long Beach CA 90810 

2d 3c 4abc*de*f 



American Red Cross 

Pasadena Chap 

Ruth A. Wong RN MPH 

PO Box 91087 

Pasadena CA 91109-1087 

2c 3b 4abcde 6bc 7bhkmu 



Prenatal Care 

Heather Bathan RN 

LA Cty Olive View Med Ctr 

7533 Van Nuys Blvd Rm 214 

Van Nuys CA 91405 

2d 3c 4abc*e 6ab 7ihmu 



N Cty Hlth Svcs 

Maternal/Child Hlth 

I rma Cota 

348 Rancheros Dr 

San Marcos CA 92069 

2b 3b 4c* 6d 7h 



San Ysidro Hlth Ctr 

Michele Burton 

4004 Beyer Blvd 

San Ysidro CA 92073 

2bc 3c 4abc*def 6d 7bhuv 



Univ CA/San Diego 

Genetics Dept 

Teri Richards 

Med Genetics M013 

La Jolla CA 92093 

2c 3b 4abc*def 6ab 7ir 



Comp Perinatal Prog 

Pub Hlth Nursing Svcs 

Antoinette Harris 

Chief Nurse 

San Diego Cty Hlth Svcs 

1700 Pacific Hwy 

San Diego CA 92101 

2d 3c 4abc*de* 6d 7chmu 



WIC Prog 

Lor a Lindblom 

American Red Cross 

3650 5th Ave 

San Diego CA 92103 

3ab 4abc*e* 6d 7nhm 



104 



RESOURCES 



Women/Infants/Children (WIC) 

Supplemental Food Prog 

Lora Lindbolm 

3650 5th Ave 

San Diego CA 92103 

3c 4abc*f* 6d 7nhm 



San Diego Comm Coll Classes 

Fami ly Preparation 

Janet Neeb 

3930 Orchard Ave 

San Diego CA 92107 

2c 3c 4abcde 6bc 7b 



Beach Area Comm Clinic 

Prenatal Prog 

Sharon Weremiuk 

3705 Mission Blvd 

San Diego CA 92109 

2d 3c 4abc*e 6bc 7hm 



SAPID--Sch Age Parenting 

Infant Devel 

Teresa P Cooper RN BS CPNP 

3299 Mercer Lane 

San Diego CA 92122 

2bc 3c 4abc 6c 7abhijkmu 



Salvation Army Door of Hope 

Maternity Prog 

Eddie Mays LCSW 

Admin Maternity Prog 

2799 Hlth Ctr Dr 

San Diego CA 92123 

2bc 3ab 4abcde 6b 7ahikm 



Parent-Toddler and Parent- 
Infant Classes 
Childrens Hosp/Hlth Ctr 
Lisa Beck 
Coord 

8001 Frost St 
San Diego CA 92123 
2bc 3c 4abcde 6c 7kh 



EOC Family Planning/Prenatal 

Clinic 

Donna Joseph 

Dir 

Econ Oppty Comm Imperial Cty 

654 Main St 

El Centro CA 92243 

2d 3c 4abc* 6d 7ihmuv 



Esperanza HS Teen Mother Prog 

Lois Cheney 

Legal Teacher 

950~Ramona Blvd #19 

San Jacinto CA 92383 

2bc3a4abcde6bc7ahmu 



San Bernardino Comm Hosp 

Obstetrical Ctr 

Jean Deetz, RN 

Dir Maternal/Child Hlth 

1500 W 17th ST 

San Bernardino CA 92411 

2d 3c 4abc*de 6bc 7bhmu 



KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asians Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d • All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k • Postnatal 'parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze preparation for delivery 
7t - Medically high-risk 
7u - Sexuallv transmitted diseases 
7v - Life skills 



Neonatal Parent Ed Prog 

Chi ldrens Hosp/Hlth Ctr 

Penny Wagner 

Coord 

8001 Frost St 

San Diego CA 92123 

2bc 3c 4abcde 6c 7kh 



Aural Rehab Parent Ed Series 

Childrens Hosp/Hlth Ctr 

D Mai chow-McCarthy 

8001 Frost St 

San Diego CA 92123 

2bc 3c 4abcdef* 7kr 



Proj I — Intact 
San Diego St Univ 
Ann Carson RN MN MS 
6505 Alvarado Rd Ste 208 
San Diego CA 92182 
2d 3a 4abc* 6bc 7tj 7jt 



San Diego St Univ Sch/Nursing 
Betty Broom RN MSN 
San Diego CA 92182 
2d 3c 4abc*de 6d 7h 



Perinatal Home Care 

Linda Levi sen RN MS 

351 N Mt View Ave 

San Bernardino CA 92415-0010 

2c 3b 4abc*de 6d 7ihmo 



San Bernardino Cty Dept 

of Pub Hlth 

Carol A Pendleton 

Prog Mgr Maternal Hlth 

404 W 9th St 

San Bernardino CA 92415-0030 

2d 3c 4abc*e 6b 7chmu 



Nutrition Svcs 

Caroline R Adame MS RD 

Chief 

Dept Hlth Cty Riverside 

PO Box 1370 

Riverside CA 92502 

2d 3c 4abc*e* 6d 7nhmuz 

Womens Hlth Prog-Indian 

Boarding Sch 

D Sherman RN FNP 

US Pub Hlth Svc 

8934 Magnol ia Ave 

Riverside CA 92503 

2b 3a 4d 6ab 7ghju 

Orange Cty Hlth Agcy 

Robert Olson 

PO Box 355 

Santa Ana CA 92702 

2d 3c 4abc*e* 6d 7ihmu 



105 



RESOURCES 



King Cty Hlth Dept 

Maternity Prog 

Edna Schroeder 

330 Campus Dr 

Hanford CA 93230 

2d 3c 4abc*d 6ab 7chim 



Prepared Childbirth Classes 

Fresno Comm Hosp & Med Ctr 

Jo Polenz 

PO Box 1232 

Fresno CA 93715-1232 

2c 3c 4abce 6b 7ihm 



Alameda Cty Comm Hlth 
Educ/Promotion Unit 
Maureen Greene SPHN 
2499-88th Ave 
Oakland CA 94577 
2d 3ab 4abc*e* 6d 7chmu 



CI inica Sierra Vi sta 

Robyn Fargo 

Hlth Educ 

PO Box 457 

Lamont CA 93241 

2d 3ab Abe* 6d 7ahijkmu 



La Leche League of N CA 
Laurie Am McVey 
11983 Midvalley Ave 
Visalia CA 93277 
2d 3ab 4abc*e* 6bc 7hm 



Comm Hlth Ctrs of Kern Cty 
Maternal Child Outreach Prog 
Marian Ansolabeheke PHN 
601 Cal ifornia Ave 
Bakersfield CA 93304 
32d 3ab 4abc 6b 7c1 



San Luis Obispo Cty 

Perinatal Prog 

Carol Grosse 

MCH Coord 

Box 1489 

San Luis ObispoCA 93406 

2d 3c 4abc*de 6bc 



Nipomo Med Ctr Perinatal Prog 

Gail Tut i no 

Box 430 

Nipomo CA 93444 

2d 3c 4abc* 6bc 7bhmu 



Madera Family Hlth Ctr 

Perinatal Care Prog 

Christine Noguera 

PO Box 2 

Madera CA 93638 

2d 3c 4abc* 6d 71hmu 



Sequoia Comm Hlth Clinic 

Ricarda Cerda MS RD 

Nutri t ioni st 

Sequoia Hlth Found 

4234 Butler 

Fresno CA 93702 

2d 3c 4abc*e* 6d 7bhmu 



Patient Ed— OB/GYN Clinic 
Stanford Univ Med Ctr 
Jeanne Walsh RN 
695 Cambridge Rd 
Redwood Cy CA 94061 
2d 3c 4abc* 6d 7ihmu 



Food £ Drug Adminis Consumer 

Affairs 

Lola Hoi land 

Consumer Affairs Ofcr 

Hlth/Human Svcs 

50 UN Plaza 

San Francisco CA 94102 

2c 3c 4abcde 6a 7bhmu 



San Francisco Perinatal 

Native American Hlth Ctr 

Joanna Oml 

Perinatal Coord 

56 Jul ian Ave 

San Francisco CA 94103 

2ac 3c 4abcde 6d 7ghmv 



Rockridge Hlth Plan 

Kim Kel ly MS FNP 

141 Leland Ave 

San Francisco CA 94134 

2d 3c 4abcde 6d 7bhmu 



American Red Cross/Palo Alto 

Area 

Al i ce L Wong 

400 Mitchell Ln 

Palo Alto CA 94301 

2d 3c 4abcde 6bc 7k 



WIC Prog--Drew Hlth Found 
Kathy Hughes MS RD 
2111 Uni versi ty Ave 
E Palo Alto CA 94303 
2b 3ab 4abce 6bc 7nhm 



WIC Prog--Solano Cty Hlth Dept 
Claudia Burnett RD 
2100 W Texas St 
Fairfield CA 94533 
2d 3c 4abc*de 6d 7nhm 



Planned Parenthood 
Lesl ie Barron 
3287 Oakland Blvd 
Walnut Creek CA 94596 
2c 3c 4abc*e 6ab 7ju 



La CI inica de la Raza 
Mara McGrath 
Med Dept Admin 
Fruitvale Hlth Proj 
1501 Fruitvale Ave 
Oakland CA 94601 
2d 3c 4bc* 6d 7b 



Native American Hlth Ctr 
Rebekah Kaplan 
3022 E 14th St 
Oakland CA 94601 
2b 3c 4b 6bc 7ghu 



Salvation Army Booth Mem Ctr 

Karen DeLeeuw 

PO Box 7023 

Oakland CA 94601 

2bc 3a 4abc 6d 7ahjku 



San Antonio Neighborhood Hlth 

Ctr Perinatal Prog 

Mi 1 dred Thompson 

La CI inica de la Raza 

1030 E 14th St 

Oakland CA 94606 

2d 3c 4abc*de*f 6d 7bhuv 



Asian Hlth Svcs 

Aimee Yan 

310 8th St Ste 200 

Oakland CA 94607 

2ab 3c 4e* 6d 7ihm 



WIC Prog--Alameda CTY Hlth Care 

Svcs Agy 

499 5th St 

Oakland CA 94607 

2d 3c 4abc*de*f* 6bc 7nhmu 



106 



RESOURCES 



Bi rthways 

Arlene Joe 

3127 Telegraph Ave 

Oakland CA 94609 

2c 3c 4abce 6d 7b 



East Bay Perinatal Coun 
Lisa Kleppel 
2955 Claremont 
Berkeley CA 94703 
2bc 3ab 4abc*de 6d 7ih 



Maternal/Child Hlth Br 

Diana Mi lee RD MPH 

CA Dept Hlth Svcs 

2151 Berkeley Way Anx 4 Rm 400 

Berkeley CA 94720 

3c 4abc*de* 6d 7chmt 



KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - W1C 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Human Relations Prog--Coop 
Ext Svc Univ CA-Berkeley 
Dorothea Cudaback 
Human Relations Spec 
US Dept Agriculture 
Haviland Hall Rm 120 
Berkeley CA 94720 
2c 3ab 4abcdef 6bc 7kh 



WIC Prog—Marin Cty Dept 

Hlth/Human Svcs 

Mary Louise Zemicke 

Civic Ctr Rm 280 

San Rafael CA 94903 

2d 3ab 4abc*de* 6bc 7nhm 



Family Hlth Found of Alviso 

OB/Family Planning Dept 

Esther Desher RN NP 

OB-FP Coord 

1621 Gold St 

Alviso CA 95002 

2c 3c 4abc*e 6ab 7bhmu 

Santa Cruz Cty Hlth Svcs Agy 

Charlene Bartholomen 

PO Box 962 

Santa Cruz CA 95061 

2c 3c 4abc*e 6d 7chmu 

WIC Prog--Watsonvi 1 le 
Food/Nutrition Svcs 
Wanda Hoelting RD 
1035 N Main St 
Watsonville CA 95076 
2d 3c 4abc*e* 6d 7nhm 

Infant Care Course for Teen 

Mothers 

Al ice Alvarez 

Dir Nursing/Hlth Svcs 

American Red Cross Santa Clara 

333 McKendrie St 

San Jose CA 95110 

2c 3a 4abc 6c 7k 

Indian Hlth Ctr of Santa 

Clara Val ley 

Joan Weagle RN PHN 

3485 E Hills Dr 

San Jose CA 95127 

2d 3c 4c*de* 6d 7chmuv 

Ctr for Life 

O'Connor Hosp 

Vicki Myers 

2105 Forest Ave 

San Jose CA 95128 

2d 3c 4abc*de 6bc 7ihm 



WIC/Delta Fami ly Ping 
Jul ie B Grunsky RD 
914 N Ctr 

Stockton CA 95202 
2d 3c 4abc*de* 6d 7nhm 



Teen Mother Prog 

Ann Bettis 

Teacher/Chmn 

Merced Union HS Dist 

P0 Box 835 

Atwater CA 95301 

2bc-3ab 4abc*e* 6bc 7ahmuv 



Stanislaus Family Hlth Ctr 

Daniel Goodman MD 

325 I St 

Modesto CA 95351 

2c 3c 4bc* 6ab 7ih 



WIC Prog--Ctr Ed/Manpower Res 

Janet Alexander 

Prog Coord 

487 S Main St 

Lakeport CA 95453 

2d 3c 4abc*de 6bc 7nhm 

WIC Prog — Mendocino Cty 

Hlth Dept 

Carolyn Nathan RN 

Courthouse 

Ukiah CA 95482 

2c 3c 4abc*de*f* 6bc 7nhm 



WIC Prog — Humboldt Cty 
730 Harris St 
Eureka CA 95501 
2c 3c 4abcde* 6d 7nhm 



Davis Free Clinic 

Perinatal Prog 

Barbara Boehler 

429 F St #6 

Davis CA 95616 

2b 3b 4c* 6d 7b 



Regional Rural Hlth Prog 

Sue Seropian 

PO Box 846 

Dixon CA 9562C 

2b 3b 4bc*d 6ac 71 hu 

Young Parents Prog 

Cris W Powel 1 

Grant Joint Union HS Dist 

3701 Stephen Dr 

N Highlands CA 95660 

3a 4abcdef 6d 7ahmu 



107 



RESOURCES 



Smoking 6 Pregnancy American 

Lung Assn-Sacramento 

Lynn Rubie 

909 12th St 

Sacramento CA 95814 

2c 3c 4abc 6ab 7mu 



WIC Prog--Butte Cty HI th Dept 

Sue Kaisier 

Proj Di r/Nutri tioni st 

695 Oleander 

Chi co CA 95926 

2d 3c 4abc*def 6bc 7nhm 



Clinica Campesina Rural 

Hlth CI inic 

Cec Ortiz 

1345 Plaza Ct N 

Lafayette CO 80026 

2c 3c 4abc*de 6d 71ahu 



CA Hwy Traffic Safety Prog 

402 Prog 

Patricia Hi 1 1 

Occupant Protection Prog Coord 

7000 Franklin Blvd 330 

Sacramento CA 95823 

2d 3c 4abc*e* 6bc 7k 



Hlth Education 

Jul i su Oimucc i 

N CA March of Dimes 

2424 Arden Way C-80 

Sacramento CA 95825 

2bc 3a 4abc 6ab 7ahmru 



Sacramento Cty Hlth Dept 

Child Hlth Disability Prev Prog 

Jeryn Bering Smith MPH 

3701 Branch Ctr Rd 

Sacramento CA 95827 

2b 3c 4bc* 6d 7cahmov 

Maternal /Chi 1 d/Adolescent 

Hlth Prog 

Fran Huertal 

Coord 

Sacramento Cty Hlth Dept 

3701 Branch Ctr Rd 

Sacramento CA 95827 

2b 3c 4abc*de* 6b 7ihmo 

WIC Prog--Sacramento Cty 
Patricia Matthews 
3701 Branch Ctr Rd Rm 205 
Sacramento CA 95827 
2d 3c 4abcdef* 6d 7nhm 

Sacramento Cty Hlth Dept 
Field Svcs (Pub Hlth Nurs) 
Ruth Brown 
3701 Branch Ctr Rd 
Sacramento CA 95830 
2d 3c 4abc*de* 6d 7chm 

School -Age Parent 6 Infant 

Devel Prog 

Carol Rice 

Dir 

Grant Joint Union HSD 

1333 Grand Ave 

Sacramento CA 95838 

2d 3a 4abc*e* 6bcd 7abhimuv 



N Sacramento Valley Rural Hlth 
Proj--Per inatal Prog 
Lea A Mason RN BSN 
4941 01 i vehurst Ave 
Olivehurst CA 95961 
2d 3c 4abc*def* 6d 71hkm 



Orland Fami ly Hlth Ctr 

Annamarie Diaz 

NCA Valley Rural Hlth Proj 

227 Swift St 

Orland CA 95963 

2d 3c 4bc* 6d 7bhmu 



Orovi 1 le Fami ly Hlth Ctr 

Rosanna Jackson 

Rur Hlth Proj 

1453 Downer St 

Orovi lie CA 95965 

2d 3ab 4abc*e 6d 71 hm 



Dept Pub Hlth/Environ Svcs 

Janet Easches 

Chalan Kanoa 

Saipan CM 96950 

2ab 3c 4c* 6d 7bh 



Hlthy Mother Healthy Baby 

Saskatoon Comm Hlth Unit 

Carol Brown 

Prog Devel Officer 

350 3rd Ave N 

Saskatoon CN S7K6G7 

2d 3c 4abcd*e 6d 7ihmuv 



WIC Prog 

Jefferson Cty Hlth Dept 

Karri A Kent RD 

7531 W 57th Ave 

Arvada CO 80002 

2bc 3c 4abc*e* 6bc 7nho 



Denver Indian Hlth Board 
Kay Culbertson Falcon 
2035 E 18th Ave 
Denver CO 80123 
2c 3c 4g 6d 7ghm 



Food 6 Drug Admin 
K.A. Brunner RD 
500 US Custom House 
Denver CO 80202 
2c 3ab 4abc* 6b 7a 



Teen Parent Educ Network 

Deborah Gi Iboy 

Prog Dir 

Human Svcs 

838 Grant Ste 400 

Denver CO 80203 

2bc 3ab 4abc* 6d 7abhkmuv 



Denver Dept of Hlth 6 Hosps 

Paul Mel inkovich MD 

777 Bannock 

Denver CO 80204-4507 

2a 3ab 7abc*de* 6d 7bhmu 



Tap Aware 

Ruth Autes 

501 East 28th Ave 

Denver CO 80205 

2c 3a 4abc 6abc 7ahmu 



Parent Educ Courses 

Mercy Med Ctr 

Kathy Black RN 

OB Superv 

16th and Mi 1 waukee 

Denver CO 80206 

2d 3c 4abc*de 6d 7bhiku 



CO Low Birth Weight 

Prevention Proj 

Carolyn Kercheck 

CO Dept Hlth 

4210 E 11th Ave 

Denver CO 80220 

2c 3ab 4bce 6b 7ihmv 



108 



RESOURCES 



WIC Prog--Jefferson Cty Hlth 

Dept 

Katie McKinley RD 

260 S Kipling 

Lakewood CO 80226 

2c 3c 4abc*de* 6d 7nhm 



Teenage Hlth Teaching Modules 

Colorado Proj, Sch Dist 12 

H E Wilson 

Dir 

Rocky Mtn Trng Ctr 

11285 Highl ine Dr 

Northglenn CO 80233 

2c 3a 4bc 6a 7ahmru 



Salud New Horizons Adolescent 

Clinic 

Carol Bandura MS CPNP 

Clinic Mgr 

1115 2nd St 

Fort Tupton CO 80302 

2bc 3a 4bc*d 6abc 7ahu 



EFNEP/CO St Univ 

Karen Wi lken 

Coop Ext Svc 

CO St Univ 200 Gifford Bldg 

Fort Collins CO 80523 

2d 3c 4abcde 6d 7dh 



WIC Prog--Pueblo Neighborhood 

Hlth Ctr 

Catherine Horeman 

1901 N Hudson 

Pueblo CO 81001 

2c 3c 4abc* 6d 7nh 



EFNEP— CO St Univ Ext Svc 

Marilyn Hill 

Ext Agent 

US Dept Agric 

Courthouse 10 6 Main 

Pueblo CO 81003 

2ab 3c 4abc* 6d 7dhm 



Maternity Prog/Tri-Cty Dist 
Hlth Dept 
Cathie Martyn 
Maternity Prog Coord 
2200 E 104th Ave 
Thornton CO 80233 
2c 3c 4abc*de* 6bc 7ihm 



KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n • WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Larimer Cty Hlth Dept 

Maternity Assistance Prog (MAP) 

Warrenetta H Underwood RN 

363 Jefferson 

Ft Collins CO 80525 

2c 3c 4abc*de 6bc 7ihmuv 



Sunrise Comm Hlth Ctr 

David J Simmons MD 

Med Dir 

1028 5th Ave 

Greeley CO 80631 

2c 3c 4bc* 6d 7ih 



Prematurity Prevention Prog 

Memorial Hosp 

Susan Bennett 

1400 E Boulder 

Colorado Spgs CO 80909 

2bc 3c 4abc*de 6b 7ihmtu 



Prenatal Clinic 

El Paso Cty Hlth Dept 

Sara Waryas CNM 

501 N Foote Ave 

Colorado Spgs CO 80909 

2c 3c 4abcde 6bc 7ihm 



Parenting Classes 
Barbara Gordon 
501 N Foote Ave 
Colorado Spgs CO 80909 
2c 3b 4abcdef 6c 7k 



Prenatal Dental Hlth Seminars 
Richard Loochtan DOS 
7824 N Academy Rd 
Colorado Sprgs CO 80918 
2d 3b 4abc 6bc 7q 



Child Devel Svcs 

Stephen M Rohar 

Dir 

Otero Junior College 

18th and Colorado Ave 

La Junta CO 81050 

2d 3c 4abc*d 6d 7khmu 



CO Prenatal Prog 

Otero Cty Hlth Dept 

110 Cty Courthouse 13 W 3rd St 

La Junta CO 81050-1591 

2bc 3c 4bc* 6d 7ihmu 



WIC Prog — Las Animas—Huerfano 

Ctys Dist Hlth Dept 

Karen Shode RD 

WIC Dir 

412 Benedicta Ave 

Trinidad CO 81082 

2d 3c 4bc* 6bc 7nhm 



Adolescent Proj 

Sara Espinoza/Vi cki Masters 

204 Carson Ave 

Alamosa CO 81101 

2c 3ab 4c 6d 7ahv 



WIC Prog 

Herbert M Mason MD 

1847 2nd St 

Alamosa CO 81101 

2d 3ab 7n 



Saguache Cty Nursing Svc 
Deena Sands RN/PHN 
Box 422 

Center CO 81125 
6ab 3c 4bc* 6d 7bhm 



109 



RESOURCES 



San Luis Valley Med 
Professional Corp 
Richard H Byers MD 
404 Morris Box 629 
Monte Vista CO 8l 1 ^4 
2c 3c 4bc* 6d 7h 



San Juan Basin HI th Dept 

Prenatal Prog 

Debby Jaworskyrn 

PO Box 140 

Durango CO 81302 

2c 3c 4abc*d 6b 7chm 



WIC Prog— CT 

CT Dept HI th Svcs 

Alma W Cain 

WIC Superv 

150 Washington St 

Hartford CT 06106 

2d 3c 4abc*e* 6bc 7nhm 



Kaiser Found Hlth Ctr 

L. Scherzer MD 

99 Ash St 

E Hartford CT 061 08 

2d 3c 4abc*de 6d 7ahu 



Teenage Pregnancy Prevention 

Prog 

Pat Watson 

232 N Elm St 

Waterbury CT 06704 

2c 3ab 4abc* 6abc 7au 



Waterbury Pub Hlth Nursing Div 

Katherine M McCorneark BSN/MPH 

232 N Elm St 

Waterbury CT 06706 

2d 3c 4abcde 6d 7bhu 



WIC Prog — Ute Mountain Tribe 
Dorothea Fury 
Toware CO 81331 
2bc 3c 4d 6d 7nhmu 



CO St Prenatal Prog 
Delta Cty Hlth Dept 
Tamara Whiteside RN 
103 W 11th St 
Delta CO 81416 
2c 3ab 4bc* 6b 7ihmou 



Inglewood Hlth Dist 
Dr. Marsha Epstein DHO 
Cy Los Angeles 
123 W Manchester Blvd 
Inglewood CO 90301 
2ab 3c 4abc* 6bc 7bhu 



Clinica de Salud del Pueblo 

Pat Peyne 

Blythe Family Hlth CI inic 

263 N Broadway 

Blythe CO 92225 

2d 3c 4abc*def 6ac 7bhu 



WIC Prog--New Britain 

New Britain Gen Hosp 

Isabel Lucco 

Nutr i tionist 

103 Hart St 

New Britain CT 06050 

2b 3c 4abc*e 6bc 7nh 



CT Alcohol & Drug Abuse Comm 

Ruth M Prior 

999 Asylum Ave 

Hartford CT 06105 

2c 3c 4a be 6a b 7m 



WIC Prog—Hartford Hlth Dept 

Laurice Howel 1 -Wi 1 1 i ams 

Prog Nutritionist 

80 Coventry St 

Hartford CT 06112 

2bc 3c 4abc*ef 6d 7nhm 



Comm Hlth Svcs 

Anita Troja 

Dir Adolescent/Pediatric Med 

520 Albany Ave 

Hartford CT 06120 

2d 3c 4abc* 6d 7abhmu 



TVCCA WIC 

Marian Swiger 

Prog Nutri tioni st 

2 Cliff St 

Norwich CT O636O 

2c 3ab 4abc*e 6d 7nho 



WIC Prog— Meri den Cy 

Janet Licese Ciarleglio 

Superv 

165 Miller St 

Meriden CT 06450 

2bc 3c 4abc* 6bc 7nhkmo 



WIC Prog— Yale-New Haven Hosp 
20 York St 

New Haven CT 06504 
2d 3c 4abc*de 6bc 7nhm 



Stay Well Hlth Ctr 

D Thompson 

Assoc Dir 

Cy Waterbury 

232 N Elm St 

Waterbury CT 06702 

2c 3c 4abc* 6bc 7khmuq 



Alcohol ism Counc 

Raymond Ferguson 

521 Post Rd 

Cos Cob CT 06807 

2d 3a 4abc 6b 7m 



Howard Univ Hosp Dept Comm 
Hlth & Fami ly Practice 
Evelyn Hal 1 MD 
915 Rhode Island Ave NW 
Washington DC 20001 
2d 3c 4abc 6d 7abhjmu 



Smoking 6 Pregnancy Prog 

(Presentations) DC Lung Assn 

Patricia Theiss 

Coord Child/Youth Prog 

475 H St NW 

Washington DC 20001 

2bc 3c 4abc* 6bc 7m 



American Red Cross/DC Chap 

Nutrition Prog-Hlth Svcs 

Myrna Maschke RD 

2025 E St NW 

Washington DC 20006 

2c 3c 4abc*e 6d 7h 



Expectant Parent Training and 
Better for Better Hlth 
American Red Cross Hlth Svcs 
2025 E St NW 

Washington DC 20006 
2c 3ab 4abc* 7bh 



DCACLD--DC Assn Children 
with Learning Disabilities 
Cordie Putt Kamner 
4225 Lenore Ln 
Washington DC 20008 
2b 3a 4abc 7k 



110 



RESOURCES 



Washington DC Parent Child Ctr 

1325 W St NW 

Washington DC 20009 

2b 3b 4ac*ef 6b 7kh 



For Your Baby's Sake — Koba Assoc 

Pat Patterson 

DC Dept Human Svcs 

2000 Florida Ave NE 

Washington DC 20009 

2bc 3c 4abc*e 6d 7ihmtu 



Comm of Caring — DC Comm 
Pub Hlth/Bur MCH 
Harry C Lynch MD 
1875 Connecticut Ave NW 
Washington DC 20009 
2d 3ab 4ac* 6bc 7c 



Perinatal Ed Exchange Prog 
Betty Ripton 
1 1 1 Michigan Ave 
Washington DC 20010 



KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health deDartment 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - W1C 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 



American Red Cross/DC Chap 
Cathy Merci 1 RN 
1*013 Minnesota Ave NE 
Washington DC 20019 
2bc 3ab 4a 6d 7hjm 



Adolescent Pregnancy Classes 
Sal 1 ie Ei ssler 
Greater Southeast Comm Hosp 
1310 Southern Ave SE 
Washington DC 20032 
2d 3a 4ab 6bc 7a ik 



Mother/Infant Devel Prog 

St El izabeths Hosp 

Eva R Gochman PhD 

2700 Martin Luther King Ave SE 

Washington DC 20032 

2d 3c 4abc*de 6d 7bkv 



Operation Stork 
Barbara Zonder Chmn 
B'nai B' ri th Women 
1640 Rhode Island Ave NW 
Washington DC 20036 
2d 3c 4abc*de 6d 7bmhr 



Better Babies—Greater 
Washington Research Ctr 
Joan Maxwel 1 

1717 Massachusetts Ave NW #403 
Washington DC 20036 
2bc 3c 4a 6b 7ihtu 



Parents Classes Prog 

Columbia Hosp for Women 

Doris Walsh RN CCE 

Dir 

2425 L St NW 

Washington DC 20037 

2c 3c 4abce 6bc 7ih 



WIC Prog — Columbia Hosp 
for Women 
2425 L St NW 

Washington DC 20037 
2d 3c 4abc*de 6bc 7nhm 



/u - sexually 
7v - Ufe skill 



Newborn Proj 

Pearl L Rosser MD 

Howard Uni v Col 1 Med 

Box 19 

Washington DC 20059 

2d 3c 4a 6c 7k 



Adolescent Med Teenage 
Pregnancy Prog 
Renee R Jenkins MD 
Howard Univ Pediatrics Dept 
2041 Georgia Ave NW 
Washington DC 20060 
2b 3a 4a 6ab 7abhijmu 



Howard Univ 

High Risk Young Peoples Proj 

Roselyn P Epps MD MPH 

Proj Dir 

Howard Univ Col 1 Med 

2041 Georgia Ave NW 

Washington DC 20060 

2d 3ab 4abc 6ab 7bihmuv 



Neonatal Care—Howard 
Univ Hosp Pediatrics Dept 
Antoine K Fommfod MD MPH 
2041 Georgia Ave NW 
Washington DC 20060 
2c 3c 4ac* 6c 7khmu 



Dept Pediatrics 

Vi rginia Randal 1 MD 

Walter Reed Army Med Ctr 

Washington DC 20307-5001 

2d 3c 4abcde 6c 7k 



WIC Prog— NE State Svc Ctr 

Natal ie McKenney 

Nutr i tionist 

500 Vanderver Ave 

Wilmington DE 19802 

2b 3c 4abc* 6bc 7nhm 



Maternal Child Hlth Svcs 

Marihelen Barrett 

Div of Pub Hlth 

Cooper Bldg 

Dover DE 19901 

2ab 4abc*ef 6d 7chmu 



DE WIC Prog— Kent and 

Sussex Ctys Mil ford St Svc Ctr 

Cynthia J Izzo 

13 Church Ave Ste 304 

Mil ford DE 19963 

2ab 3ab 4abc*f* 6d 7nhm 



111 



RESOURCES 



Nassau Cty HI th Dept 

Ruth T Adams RN 

PO Box 494 

Fernandina Bch FL 3203^-0494 

2d 3c 4abc*de* 6d 7chijku 



Bradford Cty Hlth Dept 

J Richards 

Dept Hlth Rehab Svcs 

329 N Church St 

Starke FL 32091-3498 

2c 3a 4abc 6d 7ahmu 



Gadsden Cty Pub Hlth Unit 

Rebecca Kenton ARUP 

PO Box 587 

Quincy FL 32351 

2bc 3c 4abc* 6d 7chmtu 



Volusia Cty Hlth Dept 

Janice Scott 

FL Dept Hlth/Rehab Svcs 

PO Box 9190 

Daytona Beach FL 32040 

2d 3c 4abc*e* 6b 7chijkmou 



Clay Cty Hlth Dept 

Barbara Enos 

PO Box 566 

Green Cove SprgFL 32043 

3c 4abcde 6d 7chmtu 



Columbia Cty Hlth Dept 
NJ Thomas RN CHNS 
FL Dept Hlth/Rehab Svcs 
Courthouse Basement 
Lake City FL 32055 
2d 3c 4abc*f 6d 7cuv 



Putnam Cty Hlth Dept 

Maternity & Pediatric Clinics 

Audrey Wright 

3001 Kennedy Rd 

Palatka FL 32077 

2d 3c 4abc*de 6d 7chkmu 



Pediatric Prog Family Med 

& Dental Ctrs 

Sara Tatum 

Exec Dir 

2503 President St 

Palatka FL 32077 

2d 3c 4abc* 6ac 7khmu 



Putnam Cty Hlth Unit 
PB Rowland RN 
3001 Kennedy Rd 
Palatka FL 32077 
3c 4abc 6d 7chku 



Childbirth/Parenting Ed Assn 

of St Augustine 

Virginia Greiner 

Dir Proj: OUTREACH 

20 Cordova St Ste 2 

St Augustine FL 32084 

2ab 3c 4ab 6d 7bhmuv 



Breastfeeding Promotional Proj 
Li 1 i an Abel ardo RD 
Duval Cty Pub Hlth Unit 
515 W 6th St 

Jacksonville FL 32206 
2bc 3c 4abc*e 6bc 7bhp 



Duval Cty Pub Hlth Unit 
Winifred Rivers 
Nursing Dir 
515 W 6th St 

Jacksonville FL 32206 
2c 3c 4abc*e* 6bc 7chmu 



Smoking & Pregnancy: 

Kit for Hlth Care Providers 

Christie Deputy 

Dir Smoking & Hlth Ed 

American Lung Assn/FL 

PO Box 8127 

Jacksonville FL 32239 

2d 3c 4abc 6d 7mhu 



improved Pregnancy Outcome 

Sally V. Wendt 

Act Superv Maternal/Child Hlth 

St Dept Hlth/Rehab Svcs 

Bldg 1 Rm 212 1317 Winewood Blvd 

Tallahassee FL 32301 

2d 3c 4abc*df 6b 7bhmt 



EPSDT/FL Dept Hlth/Rehab Svcs 

Gary Dominick 

Medicaid Ofc 1317 Winewood Blvd 

Tallahassee FL 32301 

2d 3ab 4abc*de 6c 7e 



WIC Prog— FL 

Ann Rhode 

1317 Winewood Blvd Twin Towers 

Tallahassee FL 32301 

2d 3ab 4abc*de*f* 6d 7nh 



Leon Cty IPO/OB Prog 

Sandra Ness 

Leon Cty Hlth Dept 

PO Box 13267 

Tallahassee FL 32308 

2D 3c 4abcdef 6ab 7c 



Bay Cty Hlth Dept 
Jeani le C Adams ARNP 
PO Box 1728 

Panama City FL 32401 
2c 3c 4abe 6c 7chju 



Dist Hlth Prog Offc — 2P0P 

Margaret Golden 

FL Dept Hlth/Rehab Svcs 

PO Box 12836 

Pensacola FL 32576 

2ab 3c 4abcdef 6d 7chmu 



Alachua Cty Continuing Educ 

for Pregnant Teens 

Oel Burk 

Coord 

1023 NW 15 Ave 

Gainesville FL 32601 

2d 3a 4a 6d 7au 

Univ of FL Family Practice 
Residency Prog 
LJ Petry MD 
625 SW 4th Ave 
Gainesville FL 32601 
2d 3ab 4ab 6bc 7bhv 



WIC Prog--N Ctrl FL 
Diane Dimperio 
730 N Waldo Rd Ste B 
Gainesville FL 32601 
2b 3ab 4ab 6d 7nhm 

Alachua Cty Pub Hlth Unit 
P Shuman 
PO Box 1327 

Gainesville FL 32602 
2bc 3c 4abce 6b 7ihmu 

Alachua Cty Pub Hlth Unit 
T R Belcoure 
730 NE Waldo Rd 
Gainesville FL 32606 
2c 3c 4abc* 6d 7chu 

N Ctrl FL MIC/FP/WIC Prog 
Univ FL Coll Med 
Charles S Mahan MD 
J-294 OB-GYN 

Gainesville FL 32610 
2d 3c 4abc 6d 7bhmnu 



112 



RESOURCES 



Lerey Cty HI th Dept 

Betty Jean Commings RNC OCNP 

PO Box 40 

Bronson FL 32621 

3c 4abce 6d 7chmu 

Improved Pregnancy Outcome Prog 

Marion Cty Pub Hlth Unit 

Judith Webb 

Comm Hlth Nurse 

PO Box 2408 

Ocala FL 32678 

2c 3c 4abc* 6bc 7ihmu 



WIC Prog — Seminole Cty Hlth Dept 
Dorothy Richards 
240 W Airport Blvd 
Sanford FL 32771 
2d 3ab 4abcde 6bc 7nhmu 

Lake Cty Pub Hlth Unit 
June M Atkinson MD 
Box 1305 

Tavares FL 32778 
2d 3c 4abc*def 6d 7chmtu 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b • Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7i - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze'preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



FL Nurses Assn 

Paula Massey 

PO Box 6985 

Orlando FL 32853 

2d 3c 4abcdef 6d 7b 



Brevard Cty Pub Hlth Unit 

El len Simmons RN 

PO Box 747 

Rockledge FL 32955 

2d 3c 4abcde 6d 7chmu 



I POP 

Indian River Cty Pub Hlth Unit 

Diane R Hersh 

2525 14th Ave 

Vero Beach FL 32960 

2c 3c 4abc* 6b 7ihu 



Martin Luther King Clinic 
Blanca Gonzalez 
Hlth Educ 
810 W Moury St 
Homestead FL 33030 
2d 3c 4abc*f* 6bc 7bhjmu 



IPO--lmproved Pregnancy Outcome 

Elizabeth Anne King ARNP 

Monroe Cty Hlth Dept 

Pub Svc Bldg Junior College 

Key West FL 33040 

2d 3c 4abc* 6b 7chkmu 



Dade Cty Pub Hlth Unit 

Maternal Child Hlth Prog 

Ruth Foden RN MSN 

Dir of Nurses 

1350 NW 14th St 

Miami FL 33124 

2d 3c 4abc*def 6d 7chmu 



Positive Start Family Couns 

Svcs Agy 

Grecia Falcon LACSW 

2190 NW 7th St 

Miami FL 33125 

2bc 3c 4abc 6bc 7khmpuv 



Coconut Grove Family Clinic 
F Rose RN 

Nursing Superv 
3230 Hibiscus St 
Miami FL 33133 
2bc 3c 4abc*d 6d 7bhu 



Uni v Fami ly Planni ng 

Univ of Miami OB/GYN Dept 

Ruth Walsh 

Nurse Coord 

1475 NW 12th Ave 

Miami FL 33136 

3c 4abc*def 6a 7ju 



Operation Child Saver Prog 

American Red Cross/Miami 

Si ma Mel lman 

Dir 

502D Biscayne Blvd 

Miami FL 33137 

2d 3b 4abc*df 6d 7kv 



Adolescent Family Life 
Demonstration Proj 
Pearl Garrick 
7200 NW 22nd Ave 
Miami FL 33142 
2bcd 3a 4a 6d 7ahmiju 



Professional Assn for Childbirth 

Ed 

Gissy Strum 

>400 SW Ave 

S Miami FL 33143 

2c 3c 4abc* 6bc 7ik 



St Vincent Hal 1 

Fintan M Muldoon 

Adm D i r 

PO Box 450278 

Miami FL 33145 

2c 3ab 4abc* 6ab 7a 



Pub Hlth Nutrition WIC Prog 

FL Dept Hlth/Rehab Svcs 

Ruth Bendinger RD 

10300 SW 216 St 

Miami FL 33170 

2bc 3ab 4abc*f* 6bc 7nhm 



Family Hlth Unit I I I 
Christine Harvey ARNS 
South Dods Comm Hlth Ctr 
10300 SW 216 St 
Miami FL 33190 
2d 3c 4abc*ef* 6d 7bhjku 



Comm Hlth of South Dade 

Ronald J Cantwel 1 MD 

Med Dir 

10300 SW 216 St 

Miami FL 33190 

2c 3c 4abc*f* 6d 7bhmu 



113 



RESOURCES 



Broward Cty Primary Hlth Care 

Jan Keith RN 

233 NW 9th St 

Pompano Beach FL 33311 

2d d3c 4abc*def* 6c 7khu 



American Red Cross Emergency 

Svcs/Broward Cty 

Chuck Gregg 

Asst Dir Emergency Svcs 

2120 W Broward Blvd 

Ft Lauderdale FL 33312 

2d 3c 4abc*e 6d 7h 



Broward Cty Pub Hlth Unit 

Hlth Educ Sect 

El len Fei ler 

Hlth Educ Dir 

2421 SW 6th Ave 

Ft Lauderdale FL 33315 

2ab 3c 4abc*ef* 6d 7chmu 



Palm Beach Cty Paraprof essional 

Ed Prog 

Barbara Hoi land RD 

Palm Beach Cty Pub Hlth Unit 

836 Evernia St 

W Palm Beach FL 33401 

2b 3c 4abcef 6d 7hov 



Palm Beach Cty Hlth Dept 

Sudith A Smith MPH 

FL Dept Hlth/Rehab Svcs 

PO Box 29 

W Palm Beach FL 33402 

2d 3c 4abc*e* 6d 7chkm 

Childbirth Preparation Classes 

Judy Herrick 

Planned Parenthood/Palm Beach 

5312 Broadway 

W Palm Beach FL 33^07 

2c 3ab 4abc 6b 7ihjm 

Optimum Growth Proj (S Cty 

Mental Hlth Ctr) 

Grace Caruso 

16155 S Military Trail 

Del ray Beach FL 33445 

2d 3c 4abc*e* 6d 7khm 

Lake Worth Comm Hlth Ctr 

Teri Chenot 

Hlth Educ 

Palm Beach Cty Dept 

110 N F St 

Lake Worth FL 33460 

2b 3ab 4abc*f* 6b 7ch 



Manatee Cty Pub Hlth Unit 

Judy Esachenko RN 

Comm Hlth Nursing Dir 

202 6 Ave E 

Bradenton FL 33508 

2d 3c 4abc*de 6d 7chu 



Hernando Cty Hlth Dept 

James M Stem MD 

Med Dir 

602 W Broad 

Brooksville FL 33512 

2d 3c 4abce 6ac 7chmu 



Improved Prog Outcome 
Jeanette Andel CH MD 
Sumter Cty Hlth Unit 
PO Box 98 

Bushnell FL 33513 
2c 3a 4ab 6b 7ahtu 



Preparation for Parenthood 

Yvonne E Stemler RN BS 

American Red Cross/Pinellas Chap 

624 Court St 

Clearwater FL 33516 

2d 3c 4abe 6d 7ihmu 



E Pasco Hlth CI inic 

Improved Pregnancy 

Teresa Couture RN 

IPO Proj 

PO Box 986 

Dade City FL 33525 

2c 3b 4ab 6b 7ih 



Bi rth Al ternat i ves 
508 45th St W 
Bradenton FL 33529 
2c 3c 4abc* 6d 7fhmu 



Improved Pregnancy Outcome 

Prenatal Prog--Paseo Cty 

Connie Payne 

Cty Hlth Unit Nursing Dir 

P0 Box 160 

New Port RicheyFL 33552 

2c 3b 4b 6bc 7ih 



Sarasota Cty Migrant Hlth Svc 

Janet Headley 

PO Box 2658 

Sarasota FL 33578 

2d 3c 4abc* 6d 71hmu 



Sarasota Cty Pub Hlth Unit 

OB CI inic 

Jonna Jung 

OB Superv 

PO Box 2658 

Sarasota FL 33578-2658 

2d 3c 4abcdf 6ab 7ihmu 



Children/Youth Hlth Prog--Parent 

Ed 

Guendolyn M Atkins RN 

Sarasota Cty Pub Hlth Unit 

2200 Ringl ing Blvd 

Sarasota FL 33578-2658 

3a 4ab 6bc 7k 



Hillsborough Cty Hlth Dept 
George Washington Sch Prog 
Carolyn A Evers RN 
1105 E Kennedy Blvd 
Tampa FL 33602 
2d 3a 4abc* 6bc 7chmuv 



Univ South 


Flori da Col 1 Medicine 


L. Barness 




Box 15 




Tampa 


FL 33612 


2c 3a 4abc 


6a 7a h 



Prenatal Educ for Low 
I ncome Women 
Dee Jeffers RN ACCE 
9479 N Forest Hills PI 
Tampa FL 33612 
2bc 3b 4abc 6bc 7ihmv 



New Life Birthing Ctr 
Elsie M Wilson CNM MSN 
621 6th Ave S 
St Petersburg FL 33701 
2c 3b 4abc 6bc 7fhmu 



Pinel las Cty Hlth Dept 

Maternity Prog 

Enrique Ballestas MD 

PO Box 13549 

St Petersburg FL 33733 

2d 3c 4abc*de* 6bc 7chkmtu 



Planned Parenthood of 

Ctl FL 

Vi rginia Mi 1 ler 

Box 1482 

Lakeland FL 33802-1482 

2c 3b 4abc*ef 6a 7jakhu 



114 



RESOURCES 



Polk Cty Hlth Dept 

Maternity Prog 

Sally T Plante RN 

Superv 

1333 N Florida Ave 

Lakeland FL 33803 

2d 3c 4abc*ef* 6d 7chmtu 



DeSoto Cty Pub Hlth Unit 
Clara C Horton RN 
Comm Hlth Nurse/MCH 
DeSoto Cty Hlth Dept 
1010 N Mills Ave 
Arcadia FL 33821 
2d 3c 4abcd 6bc 7chjmtu 



Floyd Cty Hlth Dept 

Maternity Clinic 

Lynn Brumbelow 

St Hlth Educ 

Box 1029 

Rome GA 30161 

2b 3ab 4abe 6b 7cmu 



CYESIS Prog 

Joyce Burbage 

1 1 04 N Dakota Ave 

Lakeland FL 33805 

2bcd 3a 4ab 6d 7abhmuv 



PAM Prog for Adolescent — Mothers 

Clara Horton RN 

Comm Hlth Nurse 

530 La Salona Ave 

Arcadia FL 33821 

2bc 3a 4abc 6bc 7ahijmu 



Highlands Cty Pub Hlth Unit 
Elaine C Harper OGNP 
Courthouse Annex 
Sebring FL 33870 
2d 3c 4abc*def* 6d 7chju 



Hardee Cty Hlth Dept 

Marion Rati iff RN 

Cty Nursing Dir 

PO Box 788 

Wauchula FL 33873 

2d 3c 4abc*f* 6d 7chu 



Perinatal Hlth Care 
Rebecca Laurens 
Comm Outreach Rep 
Palmetto Med Ctr 
507-Park St 
Palmetto GA 
2d 3c 4ab 6d 7bhmtu 



30268 



Governor's Ofc Hwy Safety 

Herschel Clark 

PO Box 1497 

Atlanta GA 30301 

3c 4abcde 6c 7k 



KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d-All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 



7f- 


Midwife programs 




?n 


Native American 




- Nutrition 




7i - 


Prenatal 




I 


Pre-pregnancy 




- Postnatal/parenting 




71 - 


Rural 




7m 


- Substance use 




7n 


- WIC 




7o 


Breastfeeding 




7p 


- Child abuse 




7q 


- Dental Care 




7r 


Genetic counseling, 


Dirth defects 


7s 


Lamaze/preparation 


for delivery 


7t 


Medically high-risk 




7u 


- Sexually transmitted diseases 


7v 


- Life skills 





Polk Cty Hlth Dept 

Alma L Vause RN Asst Comm 

Hlth Nursing Dir 

PO Box 1480 

Winter Haven FL 33880 

2d 3c 4abcef 6d 7chu 



Improved Pregnancy Outcome Proj 

Lee Cty Hlth Dept 

Ft Myers FL 33901 

2d 3c 4abcde 6bc 7chmu 

Improved Pregnancy Outcome Prog 

Marie B Buckley RN MN 

FL Dept Hlth/Rehab Svcs 

5748 Bass Circle 

Fort Myers FL 33907 

2c 3ab 4abc*e* 6d 7chmuv 



Hendry Cty Hlth Dept 

Susan Hoi land RN 

PO Box 278 

LaBelle FL 33935 

2d 3c 4abc* 6d 7chmtu 



Hendry-Glades Hlth Svcs 

Cynthia Norvi 1 le 

PO Box 1260 

LaBelle FL 33935 

2d 3c 4abc*df* 6d 7ch 

Cobb-Douglas Mental Hlth Ctr 

Martha Bruce MSW 

6133 Love St 

Austell GA 30001 

2d 3c 4abe 6d 7m 



Teen Parents Prog 
Rosalyn Barned 
1105 W Peachtree St 
Atlanta GA 30309 
2bc 3a 4ab 6bc 7am 



GA Dental Hlth Prog 
E Joseph Alderman DDS MPH 
878 Peachtree St NE Rm 215 
Atlanta GA 30309 
2ab 3ab 4abcdef 6bc 7qh 



POWER Line — Prenatal Outreach 

for Women Educ 

Charlotte Wi len 

Act Exec Dir 

CONTINUUM 

Ste 521 1447 Peachtree St NE 

Atlanta GA 30309 

2d 3c 4abc 6bc 7ihmuv 



Fetal Alcohol Syndrome Tsk Force 

GA Dept Human Resources 

Margaret E Cone 

878 Peachtree St Rm 320 

Atlanta GA 30309 

2bc 3c 4abcde 6ab 7m 



Fulton Cty Alcoholism 

Treatment Ctr 

Richard W Wright 

Dir 

265 Blvd NE 

Atlanta GA 30312 

2c 3c 4a be 7m 



115 



RESOURCES 



Preparation for Parenthood 
American Red Cross/Atlanta Chap 
Marilyn M Self RN 
1925 Monroe Dr NE 
Altanta GA 30324 
2b 3ab 4ab 6bc 7ihu 



Whitfield Parent/Child Ctr 

Runel le Steadman 

Dir 

PO Box 1321 

Dalton GA 30722-1321 

2d 3c 4abcdef 6bc 7khu 



Telephone Grannies 

J. Paul Powell 

St Dir 

March of Dimes 

PO Box 76^5 

Macon GA 31209 

2bc 3ab 4ab 6d 7bh 



Melds Young Moms (MYM) 

Deidra Coleman 

Child Svc and Family Coun Ctr 

Box 7948 Sta C 

Atlanta GA 30357 

2d 3ab 4ab 6c 7ah 



USDA Food & Nutrition Svc 
Nutrition & Tech Svcs SE Reg 
Peggy R Fouts MS RD 
1100 Spring St NW 
Atlanta GA 30367 
7n 



Candler Cty Hlth Dept 

Diane Bryant PHN 

PO Box 205 

Metter GA 30439 

2c 3c 4abc* 6d 7chmu 



Dawson Cty Hlth Dept 

Janice Fleming RN 

GA Dept Human Resources 

PO Box 245 

Dawnsonville GA 30534 

2c 3ab 4b 6d 7chmu 



EFNEP— Univ GA Coop Ext Svc 

Holly Alley 

Ext Nutrition Spec 

US Dept Agric 

Hoke Smith Annex-UGA 

Athens GA 30602 

2ab 3c 4ab 6d 7dhm 



Clarke Cty Comm Task Force to 
Reduce Infant Mortality 
Mar i 1 yn Favors 
468 North Mi 1 ledge Ave 
Athens GA 30610 



WIC Prog--NW Hlth Dist 

Mamie Griffin 

WIC Coord 

111 Bryant Crossing Ste AA 

Dalton GA 30720 

2d 3c 4abc* 6d 7nhm 



Chattooga Parent Child Ctr 
Paulette Burkhalter 
Nat Head Start Prog 
702 S Congress St 
Summerville GA 30747 
2d 3ab 4ab 6d 7kmhkmu 



Preparation for Parenthood 

American Red Cross/Augusta Chap 

Nurs 6 Hlth Svcs 

8l1-12th St 

Augusta GA 30901 

2c 3c 4ab 6bc 7bhmu 



Womens Hlth--Family Planning 

Maternal/Child Hlth 

Anna R Johnson 

Superv 

Laurence Cty Hlth Dept 

2121 Bellevue Rd 

Dublin GA 31021 

2bc 3c 4abe 6d 7chu 



Jones Cty Hlth Dept 

Carol Tanner 

PO Box 135 

Gray GA 31032 

2c 3ab 4ab 6d 7chu 



Oconee Ctr Alcohol & 
Drug Svcs 
Nancy Madden RN 
630 S Wilkinson jSt 
Milledgeville GA 31061 
2d 3ab 4abc 6d 7mh 



Drug Abuse Svcs 

Dept Hlth 

Helen B Sharpe 

Di r 

653 2nd St 

Macon GA 31201 

2bc 3c 4abcde 6ab 7m 



American Red Cross/Macon 

Glenna Sevy 

195 Holt Ave 

Macon GA 31201 

2c 3c 4ab 6bc 7bh 



GA Dental Assn Counc on 

Dental Hlth 

Anne C Hanse DDS 

41 19 Cangonra 

Macon GA 31210 

2c 3c 4ab 6d 7gh 



Hlth Outreach for Consumers 

- Operation Telephone Granny 

Jackie Scott 

Proj Mgr 

Macon-Bibb Cty Hlth Dept 

770 Hemlock St 

Macon GA 31298 

2ac 3ab 4ab 6d 7bhi 



Teen Clinic 

Alden Willard 

Chathan Cty Dept 

115 E York St 

Savannah GA 31401 

2bc 3a 4ab 6bc 7ahu 



Comm & Family Devel Sect 

of Tidelands Mental Hlth Ctr 

Louis F Caputo 

PO Box 23407 

Savannah GA 31^03 

2bc 3b 4ab 6c 7k 



Parent & Child Devel Svcs 
Brenda A Nelson 
Florence Crittenton Home 
535 E 54th St 
Savannah GA 31405 
2d 3ab 4ab 6bc 7ahijk 



WIC Prog--Appl ing Cty Pub 

Hlth Dept 

Jul ia Nel 1 Shaw RN 

PO Box 37 

Baxley GA 31513 

2d 3c 4abc* 6d 7nhmu 



Coastal Hlth Unit 
Billy E Griner 
1609 Newcastle St 
Brunswick GA 31520 
2c 3c 4abc*e 6d 7bhimu 



116 



RESOURCES 



Thomas Cty HI th Dept 
PO Box 148 

Thomasville GA 31792 
2d 3c 4abcde 6d 7chkm 



EFNEP— GA 

Donna L Downen 

GA Ext Agent 

US Dept Agric 

Government Ctr — East Wing 

Columbus GA 31993 

2d 3c 4abcde 6d 7dhmu 



HI th Educ Ofc Dept of Pub 

Hlth/Soc Svcs 

Karen Cruz 

PO Box 2816 

Agana GU 96910 

2b 3c 4abe* 6d 7chmu 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7i - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Maui Childbirth Ed Assn 

Sandy Dioso RN 

Dir 

95 Mahal ani St Cameron Ctr 

Wailuku HI 96793 

2c 3c 4bce 6bc 7ih 

Expectant Parents Classes 

Queen's Med Ctr 

Jayne Hull RN 

1301 Punchbowl 

Honolulu HI 96813 

2bc 3c 4abcde* 6d 71ikh 

Maternity Infant Care Proj 
Maternal/Child Hlth Br 
Loretta Fuddy 
Sec Superv 

HI Dept Hlth/Fam Hlth Svcs 
741-A Sunset Ave 
Honolulu HI 96816 
2b 3c 4be 6d 7c 



Kaiser Found Hlth Plan 

Richard F Knobel 

Proj Dir 

810 N Vineyard Blvd 

Honolulu HI 96817 

3ab 6bcde 6d 7bh 



Parent Child Ctr of HI (PACT) 
Hana Lake Home Visitor Prog 
Diana Buckley 
1475 Una Puni St Rm 117A 
Honolulu HI 96819 
2bc 3c 4e 6bc 7k 



Teen Intervention Prog 

Jane E Hale 

Admin 

Kapiolani Womens/Chld Med Ctr 

1319 Punahey St 

Honolulu HI 96822 

2c 3a 4abe 6d 7ahtu 



Pohai Poho-Booth Svcs Prog 

Salvation Army Treatment Fac 

Amy Watts 

Superv 

2950 Manoa Rd Cottage C 

Honolulu HI 96822 

2d 3c 4abcdef 6bc 7khijmuv 



EFNEP— Univ HI Coop Ext Svc 

Marian D Rauch 

US Dept Agric 

122 Gilmore Hall 3050 Maile Way 

Honolulu HI 96822 

2c 3b 4b 6bc 7dhm 



Hawaii Lamaze Assn 
Astrid Jackson 
2825 S King St #1902 
Honolulu HI 96826 
2bc 3c 4abcde* 6bc 7ghm 

WIC Prog—Chi ldrens Svcs/Ctl IA 

Jan Kraemer 

WIC Coord/Nutritionist 

127 Sumner 

Ames IA 50010 

2d 3c 4abc*de* 6d 7nh 

Children Svcs Ctl IA— Well 

Child Prog 

Sheila Baker CPNP 

127 Sumner Ave 

Ames IA 50010 

2d 3c 4abc*e* 6bc 7hq 

WIC Prog— IA 

Laura Sands 

Dir WIC Prog 

3rd F1 Lucas Bldg 

Des Moines IA 50310 

2d 3c 4abc*de* 6d 7nhm 

Commodity Supplemental Food Prog 

I A Dept Human Svcs 

Paul ine Walton 

Hoover St Ofc Bldg 1st Fl 

Des Moines IA 50319 

2d 3c 4abc*de* 6bc 7h 



Maternal Hlth Ctr 

300 15th St NE 

Mason City IA 50401 

2c 3c 4abc*def 6bc 7ih 



Butler Cty Pub Hlth Nursing Svc 
Courthouse Box 325 
Allison IA 50602 
2d 3c 4b 6d 7kh 



WIC Prog 

Katherine Kirkdorffer MS RD 
120 Independence Ave 
Waterloo IA 50703 
2d 3c 4abe 6bc 7nh 



Woodbury Cty Comm Action Agy 

WIC/Well Child 

Dolores Duncan RN 

Prog Dir 

2700 Leech Ave 

Sioux Cy IA 51106 

2ab 3ab 4abc*de* 6d 7nhmu 



117 



RESOURCES 



WIC Prog--Pottawattamie Cty 
Beth Stockley RD 
Courthouse Annex 223 S 6th St 
Council Bluffs IA 51501 
2bc 3c 4abcde 6d 7nhjm 



Medical /EPSDT I A Dept Human Svcs 

Kathi Keller 

Hoover State Ofc Bldg 

Des Moines I A 58319 

2d 3c 4abcdef 6d 7e 



WIC Prog— Panhandle Hlth Oist I 

Jean Zahalka RN 

PO Box 734 

Sandpoint ID 83864 

2c 3c 4b 6d 7nhmu 



Hillcrest Family Ping Clinic 

Char Redwine 

2005 Asbury Rd 

Dubuque IA 52001 

2c 3c 4abe 6ac 7jhmuv 



Maternal 6 Infant Care 

Grace Guy RN FND 

Publ ic Hlth Dist I I I 

PO Box 489 

Caldwell ID 836O6 

2d 3c 4abc*f 6bc 7bhkm 



La Leche League International 

Jul ie Stock 

PO Box 1209 

Franklin Park IL 60131-8209 

2d 3c 4abc*de 6bc 7okh 



WIC Prog — Johnson Cty Hlth Dept 

Cynthia Tholen RD 

1105 Gilbert Ct 

Iowa Cy IA 52240 

2d 3c 4abce 6d 7nh 



Comm Hlth CI inics 

Marcia Bondy 

1515 3rd St N 

Nampa ID 83651 

2b 3c 4bc*de 6d 71hmu 



IL Dept Pub 

Hlth Nutrition Svcs 

Jan Kal 1 io MS RD 

245 W Roosevelt Rd Bldg 5 

W Chicago IL 60185 

2bc 3c 4abc 6d 7h 



College Dentistry - U IA 
Arthur J Nowak 
Iowa City IA 52242 
2d 3c 4abc*de*f 6ac 7q 



Visiting Nurse Assn 
Nancy Alleman RN/CPNP 
Maternal Child Hlth Coord 
400 3rd Ave SE 
Cedar Rapids IA 52401 
2d 3c 4abc*e 6d 7bhmu 



Lee Cty Hlth Dept 

Sandra Hennies RN 

933 Ave H 

Ft Madison IA 52627 

3ab 4abe 6bc 7h 



Family Planning 6 Maternal 

Hlth Svcs 

Carol Ful lerton 

300 Tucker Bldg 

Clinton IA 52732 

2d 3c 4abcdef 6ab 7ijhru 



YWCA Parenting Prog 

Kay Jackman 

Prog Coord 

YWCA 

309 Sycamore St 

Muscatine IA 52761 

2d 3ab 4bc* 6bc 7khmp 



Comm Hlth Care 
428 Western Ave 
Davenport IA 52801 
2d 3c 4abc*de* 6ac 7khu 



Salvation Army Booth Mem Home 

Maj Shirley Goode 

Admin 

PO Box 7686 

Boise ID 83707 

2d 3ab 4bc 6bc 7ahu 



St Lukes Reg Med Ctr 

Parenting Prog 

Anne Peyron RN 

Coord 

190 E Bannock 

Boise ID 83712 

2c 3a 4bc 6b 7ik 



Maternity and Infant Care Prog 
Col leen C Hughes RN PHD 
ID Dept Hlth/Welfare 
Bureau of Child Hlth Sthse 
Boise ID 83720 

2d 3c 4abc*de 6d 7chmu 



Help Yourself to Hlth 
ID Dept Hlth/Welfare (WIC) 
Karen Dalenius RD MPH 
WIC Nutrition Ed Coord 
450 W State St 4th Fl 
Boise ID 83720 

2b 3ab 4bc* 6d 7nh 



Parent/Infant Toddler Coop 
Univ ID Home Econ 
Janice Fletcher 
Moscow ID 83843 
2c 3c 4bcde 6c 7k 



Mother/Child Nutrition Prog 

(MAC) 

Jean Davis MS RD 

Dir 

Cathol ic Char i ties 

721 N LaSalle Dr 

Chicago IL 60605 

2b 3c 4abc*def 6bc 7h 



Adolescent Family Ctr 
M C Brucker CNM 
Presbyterian St Lukes Med Ctr 
1725 W Harrison Ste 436 
Chicago IL 60612 
2d 3ab 4abd 6a 7ahimpuv 



Preparation for Childbirth 

Claretian Med Ctr 

Ramona Lopez FNP 

Dir Patient Educ 

2945 E 91st St 

Chicago IL 6061 7 

3c 4abc* 6d 7ih 



Roseland Comm Hosp 
Patricia Trerney RN 
45 W 111th St 
Chicago IL 60628 
2c 3c 4ac* 6d 7bhmu 



Chicago Osteopathic Med Ctr 

D Taylor RN 

CI inic Coord 

1000 E 53rd St 

Chicago IL 60637 

2bc 3c 4a 6bc 7ihm 



118 



RESOURCES 



Chicago Comp Care 

Ctr (4Cs) 

Lee Ryan 

Dir 

3639 S Michigan 

Chicago IL 60653 

2bc 3ab 4a 6d 7ahuv 



The Young Parents Prog 
Miriam Paull-Social Worker 
Prog Coord 
836 W Wei Ungton 
Chicago IL 60657 
2c 3a 4abc 6be 7ab 



Comm Hlth Nurs Fam Plgn Prenatal 

CI inics Hlth Conf 

Nursing Di v 

Lake Cty Hlth Dept 

3010 Grand Ave 

Waukegan IL 6O685 

2d 3c 4abc*e 6d 7bhm 



Perinatal Primary Prevention 

Prog 

Pat 01 iver 

Coord 

Rockford Mem Hosp 

2400 N Rockton Ave 

Rockford IL 61101 

3c 4abc* 6bc 7bhijkmu 



Swedish American OB & 
Pediatrics CI inics 
Judy Johnson RN 
1400 Charles St 
Rockford IL 61108 
2c 3c 4abc*de* 6bc 7ihmu 



Prenatal Grant 
Peoria Cy-Cty Hlth Dept 
Barbara Becker RN 
2116 N Sheridan Rd 
Peoria IL 61604 
2c 3ab 4abc 6b 7ih 



Shawnee Network of Adolescent 

Pregnancy and Parenting 

Fred Isberner 

Adolescent Hlth Ctr 

PO Box 739 

Carbondale IL 62903 

2cd 3ab 4ab 6d 7ahmu 



Southern Seven Hlth Dept Parents 

Too Soon Prog 

Myra Wood Bennett 

Dir of Social Svcs 

IL Dept Pub Hlth 

Rt 1 

Ullin IL 62992 

2d 3ab 4abc* 6d 7chjmu 



Parents and Babies Prog 
Jo Holt 

2340 E 10th St 
Indianapolis IN 46201 
2c 3ab 4ab 6bc 7kh 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e • EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7i - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n • WIC 

7o • Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t • Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



New Horizons 

Mary M Boyd 

Tri-Cty Urban League 

317 S MacArthur Hwy 

Peoria IL 61605 

3a 4abc 6d 7ahk 



WIC Prog 

McLean Cty Hlth Dept 

Capitola Stanley 

905 N Main 

Normal IL 61761 

2d 3c 4abcde 6d 7nhm 



Family Svc 6 Visiting 

Nurse--Maternal/Child Hlth 

Kay Mueggenburg RN 

211 E Broadway 

Alton IL 62002 

2d 3ab 4abcde*f 6bc 7ihmu 



WIC Prog--Wabash Hlth Dept 

Sharon Vaughan 

107 NE 2nd St 

Fairfield IL 62837 

2d 3c 4abcde 6d 7nh 



Maternal & Infant Care Proj 

Kim Woock RD 

Proj Nutrition Coord 

Marion Cty Hlth Dept 

362 W 15th St 

Indianapolis IN 46202 

2d 3c 4abe 6bc 7cahkmu 



Nei ghborheal th 
Joanne Greer 
3122 Bethel Ave 
Indianapolis IN 46203 
2d 3c 4ab 6d 7k 



Indianapolis Urban League/ 
Human Svcs Dept 
Ruth A Sims Brooks 
850 N Meridian St 
Indianapolis IN 46204 
2c 3a 4a 6ab 7a 



Fetal Alcohol Syndrome Prevent 

Effort 

Anne Pinnick 

IN Counc/Alcohol ism/NCA 

2511 E 46th St Bldg S 

Indianapolis IN 46205 

3c 4abc* 6d 7m 



Expectant Teen Outreach 
Homes for Black Children 
3131 E 38th St 
Indianapolis IN 46218 
3ab 4a 6bcd 7abhijv 



119 



RESOURCES 



WIC Prog--Marion Cty 
Georgina Rowland 
2802 Lafayette Rd Ste 2 
Indianapolis IN 46222 
2d 3c 4abc*de* 6d 7nhmt 



Well Child Clinic--Land of Lakes Hlthy Babies 



Fami ly HI th Svcs 

Joyce Gutstein RN 

314 W Maumee 

Angola IN 46703 

2c 3c 4b 6c 7kh 



Jan Renner 

Southern Hills Mental Hlth Ctr 

PO Box 245 

Jasper IN 47546 

2c 3b 4b 6ab 7ih 



Prenatal Clinic for Low 

I ncome Women 

Annamaria S Herdon RD MHS 

Dir 

Visiting Nurse Assn/NW IN 

6513 Kennedy Ave 

Hammond IN 46323 

2bc 3c 4abcd 6b 7ihmu 



American Red Cross 
Allen-Wells Chap 
Laura Cato 

Dir Nursing Hlth Svcs 
1212 E California Rd 
Fort Wayne IN 46825 
2d 3c 4abc*de* 6d 7bhmtu 



WIC Prog--Warrick Child 

Hlth Svcs 

Karin Strunk 

920 Mil lis Ave Ste 101 

Boonville IN 47601 

3c 4ab 6bc 7nhv 



Chi ldren/Youth Clinic 

Gary Hlth Dept 

1145 W 5th Ave 

Gary IN 46402 

3c 4abc*e 6c 7kh 



IN Hlth Ctr/AYM Prog 
Joan T Radecke 
2725 S La Fountain 
Kokomo IN 46902 
2b 3ab 4abc* 6d 7ahkmu 



WIC Prog — Gibson Cty 

Laura Kropp RN 

PO Box 505 

Princeton IN 47670 

2b 3ab 4ab 6d 7nh 



Elkhart Cty Hlth Dept 

Ann Checchio 

Dir Comm Hlth Nurs 

315 S 2nd St 

Elkhart IN 46514 

2ab 3ab 7abce 6d 7chku 



Prepared Childbirth Classes 
Cesarean Birth Classes 
Kathy Renie BA CCe 
PO Box 187 5178 N 300 W 27 
La Fontaine IN 46940 
2bc 3c 4abc*e* 6bc 7ihmu 



WIC Prog--Evansvi 1 le/Vanderburgh 

Cty Dept Hlth 

Monica R Hochgesang RD 

Civic Ctr Rm 127 

Evansville IN 47708 

2d 3c 4abc*de* 6bc 7nhm 



Basics of Positive Parenting 

Diane Betchel 

New Day Parent-Child Soc 

PO Box 773 

Elkhart IN 46515 

2ab 3b 4ab 6bc 7kp 



Nurses Concerned for Life 

Rose Smal ley RN 

720 S Wabash St 

Wabash IN 46992 

2d 3ab 4b 6d 7ahmu 



Breastfeeding Classes 

St Marys Med Ctr Clinic Prog 

Esther Kel ley 

RR 7 Box 156 

Evansville IN 47712 

2c 3b 4abe 6bc 7om 



Maternal 6 Child Hlth Div 

WIC— Elkhart Cty Hlth Ctr 

Jul i a Leatherman 

Dir 

320 W High St 

Elkhart IN 46516 

2b 3ab 4abc*def 6b 7nhmu 



North Central Indiana Reg 

Genetics Ctr 

Harvey A Benoer PHD 

Memorial Hosp 

615 N Michigan St 

South Bend " IN 46601 

2c 3c 4abc* 6d 7br 



Cameron Hosp Prepared 

Childbirth Class 

June Bruner RN 

416 E Maumel 

Angola IN 46703 

2bc 3c 4b 6bc 7ih 



WIC Prog — Rural Hlth Activities 

of SE IN 

Pat Esti rman RD 

WIC Coord 

605 Wilson Creek Rd 

Lawrenceburg IN 47025 

2d 3c 4abc 6bc 7nh 



Ripley Cty Hlth Coalition 

Connie DeBurger 

Proj Dir 

240 W Cravens St 

Osgood IN 47037 

2c 3ab 4b 6bc 7bh 



Wayne Cty Maternity Clinic 
Mary Back RN 
Wayne Cty Courthouse 
Richmond IN 4737^ 
2c 3c 4abd 6b 7ihmu 



OB/GYN CI inic 
St Marys Med Ctr 
W Thomas Spain MD 
3700 Washington Ave 
Evansville IN 47750 
2bc 3c 4abe 6d 7bhmu 



WIC Prog—Clay Cty 
Donna Youngblood RD 
National Guard Armory 
Brazil IN 47834 
2b 3ab 4ab 6d 7nh 



Jefferson Cty Maternal/Child 

Hlth Prog 

Jul ianne Pottorf RN 

Admin 

Jefferson Cty Hlth Dept 

Box 324 

Oskaloosa KS 66066 

2d 3c 4abcdef 6d 7chmu 



120 



RESOURCES 



Social Services 

Alma V Wi nston 

Salvation Army 

500 N 7th 

Kansas City KS 66101 

2d 4abc*d 6bc 7hmu 



Preparation for Parenthood 

Teresa Reading 

American Red Cross/Wyandotte Cty 

1600 Washington Blvd 

Kansas City KS 66102 

2d 3c 4ab 6bc 7bh 



KS Dept HI th/Envi ronment 
Maternal/Child HI th Prog 
Patricia Schlosser 
Forbes Field 

Topeka KS 66620 
2c 3c 4abc*de* 6d 7chu 



Kansas Cy (KS) Wyandotte Cty 

Hlth Dept 

Margaret Daly RN NC 

619 Ann Ave 

Kansas Cy KS 66101 

2d 3c 4abc*de 6d 7ihmu 



WIC Prog--Kansas Cy-Wyandotte 

Cty Hlth Dept 

Barbara O'Neal MS RD 

619 Ann Ave 

Kansas Cy KS 66101 

2d 3c 4abcde 6d 7nh 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage) s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d ■ All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f- Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 



7j - Pre-pregnancy 
7k- ~ 



Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze'preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Black Family Preservation Proj 

Black Adoption Prog & Svcs 

Janice Greene 

Kansas Childrens Svc League 

PO Box 1308 

Kansas City KS 661 17 

3ab 4a 6ab 7au 



La Leche League of MO 

Brenda Rockers RN 

5244 Maple 

Mission KS 66202 

7ok 



Junction Cy/Geary Cty Hlth Dept 

Mother/Infant Prog 

Box 282 

Junction City KS 664^1 

2c 3ab 4abcde 6d 7chmu 



Hlthy Start Prog 

LTC Jackie J McEntire 

USA MEDDAC 

Preventive Med Svc 

Ft Riley KS 66442 

2c 3av 4abc*de 6bc 7khmp 



EFNEP/KS St Univ 

Grace M Lang 

Coop Ext Svc KS 

201 Umberger 

Manhattan KS 66506 

2bc 3ab 4abc*de 6d 7dhm 



Pottawatomie Cty Hlthy 

Start Home Visitor Prog 

Rita McLean RN 

320 Main 

Westmoreland KS 66549 

2d 3c 4bd 6c 7kh 



Hlthy Start Home 

Visitor Prog 

Karen Barquest PHD 

KS Dept of HI th/Envi ron 

Forbes Field 

Topeka KS 66620 

2d 3c 4abc*de* 6d 7bhikp 



Home Lamaze Classes 
M Mournine RN ACCE 
931 Foulk Dr 

Belle Plaine KS 67013 
2c 3c 4abc*def 6bc 7ihs 



Barber Cty Comm Hlth Dept 
117 E Kansas 

Medicine Lodge KS 67104 
2c 3b 4b 6b 7chm 



Hlthy Start 
Harrey Cty Hlth Dept 
Roberta Stevenson RN 
P0 Box 687 Courthouse 
Newton KS 67114 
2d 3c 4abc*e 6c 7ih 



Preparation for Parenthood 

Parenting Your Child from 1-6 

Cindy Mclntyre RN 

Dir Nursing Hlth/Svcs 

American Red Cross/Midway KS Chp 

107 N Main 

Wichita KS 67203 

3c 4abe* 6bc 7kh 



Wesley Med Ctr 

Div of Perinatal Med 

John F Evans MD 

550 N Hillside 

Wichita KS 67208 

2b 3ab 4ab 4e 6be 7ihmu 



Natural Fami ly Ping 

St Francis Reg Med Ctr 

Helen VenJohn 

Superv 

929 N St Francis 

Wichita KS 67214 

2bc 3c 4abc*de*f 6ab 7jihmu 



WIC Prog/Migrant Hlth 

Sherman Cty Hlth Dept 

Joyce Jones RN 

807 Main 

Goodland KS 67735 

2d 3c 4abc* 6d 7nhmu 



121 



RESOURCES 



WIC Prog — Marion Cty 
Lucy Brown RN 
516 N Spalding Ave 
Lebanon KY 40033 
2c 3c 4ab 6d 7nhm 



Louisville Commodity 

Supplemental Feeding Prog--KY 

L i sa Good 

PO Box 1913 

Louisville KY 40201 

2d 3c 4abc 6bc 7nh 



KY Dental Assoc 

Detlef B Moore 

Exec Dir 

19^0 Princeton Dr 

Louisville KY 40205 

2b 3b 4abcdef 6c 7q 



HI thy Mothers Healthy 
Babies Month 
Shana Funk 
Reg Prog Coord 

March of Dimes Cardinal Chap 
4801 Sherburn Ln Ste 211 
Louisville KY 40207 
2d 3c 4ab 6d 7ihmru 



Smoking 6 Pregnancy Prog 

American Lung Assn/KY 

Mike Stauf acker 

Hlth Ed Dir 

PO Box 8405 

Louisville KY 40208 

2c 3c 4ab 6b 7m 

Louisvi 1 le/ Jefferson Cty 

Head Start/Parent Child Ctr 

Mary J Fant 

Mgr I I 

1809 S 34th St 

Louisville KY 40211 

2c 3c 4abf 6d 7kahmpu 

Prenatal Prog 

Park DuValle Comm Hlth Ctr 

Frederick L Steed 

1817 S 34th St 

Louisville KY 40211 

2c 3b 4a 6d 7ihm 

Louisville Mem Primary 
Care Ctr 
Emily Gage RN 
2215 Portland Ave 
Louisville KY 40212 
2d 3c 4abce 6d 7bhmu 



Mother-Child-Hlth-Nutrition 
Di rect Counsel ing 
Margaret S Brooks 
Mercer Cty Hlth Ctr 
41 1 N Greenwel 1 
Harrodsburg KY 40330 
2d 3ab 4ab 6d 7h 



Prenatal Class/Baby Care Class 

Linda Leber RN 

Ephrain McDowell Mem Hosp 

217 S 3rd St 

Danville KY 40422 

2bc 6ac 4ab 6bc 7bhkm 



Lincoln Cty Hlth Dept 

Mary Evans ARNP 

PO Box 165 

Stanford KY 40484 

2d 3c 4abcdef 6d 7chijkmu 



Maternal Child Hlth 

Evelyn Carter 

Lexington Fayette Cty Hlth Dept 

650 Newtown Pike 

Lexington KY 40508 

3c 4ab 6bc 7chmu 



Comm Advisors for 

Breastfeeding Mothers 

Carol Bryant 

KY Dept Human/Res 

650 Newton Pike 

Lexington KY 40508 

2d 3ab 4ab 6bc 7ok 



KY Occupant Restraint Prog 

KY St Police 

Dave Salyers 

919 Versailles Rd 

Frankfort KY 40601 

2c 3b 4ab 6c 7k 



WIC Prog— KY 

Peggy S Kidd 

Mgr Nutrition Br 

Department for Hlth Svcs 

275 E Main St 

Frankfort KY 40621 

2d 3c 4abcde 6bc 7nhm 



Prenatal Prog Whitley 

Cty Hlth Dept 

Joanna Cox RNC 

PO Box 147 

Williamsburg KY 40769 

2c 3c 4b 6b 7ihu 



Bell Cty Hlth Dept 

Prenatal Prog 

Brenda Johnson RN 

Box 97 

Pineville KY 40977 

2c 3c 4ab 6b 7ihmu 



WIC Prog—Martin Cty 

Geneva Crum 

PO Box 354 

Inez KY 41224 

2c 3ab 4b 6bc 7nh 



WIC Prog— Big Sandy Dist 

Hlth Dept 

Diane Blackburn 

WIC Clerk 

Box 1 1 1 Wood & 2nd St 

Paintsville KY 41240 

2d 3c 4ab 6bc 7nh 



WIC Prog— Letcher Cty Hlth Ctr 

El i zabeth Cox 

Box 300 

Whitesburg KY 41858 

2d 3c 4ab 6d 7nh 



Union Cty Hlth Dept 

Prenatal Prog (MCH) 

Muriel Casey RN 

Superv 

Box 88 

Morganfield KY 42437 

2d 3ab 4ab 6bc 7chmu 



Lincoln Trail Prenatal Prog 

Katharine Dye RN 

Licoln Trail Dist Hlth Dept 

Box 2026 

Elizabethtown KY 42701 

2d 3c 4abc*e 6ab 7chmu 



Adair Hlth Ctr 

Virgil L Clazand RNC 

Lake Cumberland Dist Hlth Dept 

103 Reed St 

Columbia KY 42728 

2d 3c 4abf 6d 7chju 



Breckinridge-Grayson Prog 

Cleo Lowrey 

Exec Dir 

PO Box 63 

Leitchfield KY 42754 

2d 3c 4abcd 6d 7km 



122 



RESOURCES 



Childbirth Ed Classes 
Debbie Herbener 
Mt Carmel Med Ctr 
Centennial S Rouse 
Pittsburg Ks 66762 
2c 3b 4abcdef 6bc 7ihm 



Maternal and Chi Id Hlth 

Charles Myers 

Acting Admin 

PO Box 60630 Rm 613 

New Orleans LA 70160 

2d 3c 4abc* 6d 7bhikmu 



EFNEP/MA Prog 

Lesl ie Turner 

Nutrition Spec 

Coop Ext Svc MA 

Univ MA 206 B Chenoweth Lab 

Amherst MA 01003 

2d 3c 4abc*def 6d 7dh 



Postpartum Teaching Prog 

Sharon Cusanza 

Head Nurse OB/GYN 

Tulane Med Ctr Hosp 

1415 Tulane Ave 

New Orleans LA 70112 

2c 3c 4abc 6c 7khjv 



Terre Bonne Parish Hlth Unit 

Grace T Gary RN 

Nurse Superv 

LA Dept of Hlth 

PO Box 309 

Houma LA 70363 

2c 3a 4abd 6d 7bh 



La Leche League 

Lavada Wri ght 

ACL for MA/VT 

16 Hanward Hill 

E Longmeadow MA 01028 

2c 3c 4abcd 6d 7ho 



Commodity Supplemental Food Prog 
Gregory Ben Johnson 
2908 S Carroll ton Ave 
New Orleans LA 70118 
2d 3a 4abcdef 6d 7nh 



Maternity Prog & FP OUACHITA 

Parish Hlth Unit 

LA Dept Hlth/Human Resources 

Box 4460 

Monroe LA 71201 

2b 3ab 4abde 6d 7mh 



Our Lady of Providence 

Childrens Ctr 

Allison Farrington ACSW 

2112 Riverdale St 

W Springfield MA 01089 

2d 3c 4abc* 6d 7bh 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c • 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7 1 - Prenatal 
7i - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Movehouse Hlth Unit 

Melanie Dew RN 

Box 152 

Bastrop LA 71220 

2c 3b 4ab 6d 7bh 



E Carrol 1 Parish Unit 

MCH Family Planning VD Control 

CS Butler RN 

LA Dept Hlth/Human Resources 

407 2nd St 

Lk Providence LA 71254 

2d 3c 4abcdef 6d 7bhiju 

EPSDT/E Carroll Parish Hlth 

Unit 

CS Butler Rn 

LA Dept Hlth/Human Resources 

407 2nd St 

Lk Providence LA 71254 

2d 3c 4abcdef 6d 7ehu 

WIC Prog--LA 

Dept Hlth/Human Resources 

Rose Hammock 

PO Box 17 

Jena LA 71342 

2d 3c 4abcdef 6d 7nhm 



Avayelles Parish Hlth Unit 

Dolores Gremillion RN PHN II 

Superv 

LA Dept Hlth Human Resources 

109 Government St 

Marksville LA 71351 

2d 3c 4abd 6d 7chpu 



Cty Adolescent Network 

of Berkshire 

Anne M Lange 

Ctl Berkshire Coord 

150 North St 

Pittsfield MA 01201 

2c 3ab 4ab 6bc 7abik 



High Risk Mother & Infant Prog 

Joyce Hall BSN 

Visiting Nurse Assn 

PO Box 877 

Pittsfield MA 01202 

2c 3ab 4ab 6d 7ahmu 



Hlth/Support Svcs 

Lyn C Bi 1 lman-Gol emme Med LCSW 

114 Ruggles St 

Westborough MA 01581 

2c 3c 4b 6bc 7ktv 



EFNEP/MA Prog 
Mary G Toth 
Coop Ext Svc MA 
Univ Ma 10 Edward St 
Worcester MA 01605 
2d 3c 4abc*de*f 6d 7dh 



WIC Prog--Worcester 

Sara Stoddard 

Nutri tionist 

32 Great Brook Valley Ave 

Worcester MA 01605 

2d 3c 4abc*de* 6bc 7nhm 



123 



RESOURCES 



Comprehensive Svcs to 

Young Parents 

Carol R Epstein 

Prog Dir 

Worcester Children's Friend Soc 

21 Cedar St 

Worcester MA 01609 

2c 3ab 4abc* 6bcd 7abhikv 



Leominster Hosp Prenatal Clinic 

Joyce Ricker CNM 

68 Shore Dr 

Concord MA 01742 

2c 3c 4abc*de 6d 7iahmouv 



Smoking Prevention--Ctr 

for Hlth Promotion 

Nancy Lichter 

MA Dept Pub Hlth 

150 Tremont St 7th Fl 

Boston MA 02111 

2c 3c 4abc 6d 7m 



WIC Prog— MA Dept Pub Hlth 

Joan Doyle 

150 Tremont St 

Boston MA 02111 

2bc 3c 4abc*de*f* 6bc 7nh 



Comprehesive Adolescent Hlth 
Prog/Young Parents Prog 
J Tuakl i-Wi 1 1 iams MD MPH 
20 Whittier ST 
Boston MA 02120 
2abc 3ab 4ac* 6d 7ahuv 



Prenatal Svc 

Mattapan Comm Hlth Ctr 

Brenda Burrel 1 

1425 Blue Hill Ave 

Mattapan MA 02126 

2d 3b 4ae* 6b 7ih 



WIC Prog 

Linda Cecchetti 

Prog Dir 

25 Locust St 

Haverhill MA 01830 

2d 3c 4abc*de 6d 7nh 



Consortium for Pregnant and 
Parenting Teens (CPPT) 
Candance Lowe, Sc D 
Brigham and Womens Hosp 
75 Francis St 
Boston MA 02115 
2d 3a 4abc 5a 6d 7ahimu 



Maternal Infant Care Project 
El izabeth Hickey RN 
Clinic Coord 
St Margaret's Hosp 
Laboure' Ctr 376 W 4th St 
S Boston MA 02127 
2bc 3c 4bde 6bc 7bhmu 



WIC Prog--Greater Lawrence Comm 

Action Counc 

Evelyn Kocher-Ahern 

Di r/Nutri tionist 

350 Essex St 

Lawrence MA 01840 

2d 3c 4abc*de*f* 6d 7nh 

Prenatal Classes/Prepared 
Childbirth Classes 
Patricia Mirisola RN 
Greater Lawrence Family Ctr 
150 Park St 

Lawrence MA 01841 
2bc 3b 4bc* 6b 7ihm 

Proj PREPARE 

Arnita T. Harvey 

Catholic Family Svcs 

55 Lynn Shore Dr 

Lynn MA 01902 

2bc 3ab 4abc* 6d 7ahmu 

MCH Primary Care 

Di v Fami ly Svcs 

Barbara Polhamus 

MA Dept Pub Hlth 

150 Tremont St 3rd Fl 

Boston MA 02111 

2c 3c 4abc*e 6d 7ih 



South Cove Comm Hlth Ctr 
OB Team 

Martha Jane Hackett CNM 
885 Washington St 
Boston MA 02111 
2ab 3c 4e* 6bc 7ih 



Affiliated Neighborhood Hlth 

Ctrs OB-GYN Group Practice 

Luci 1 le Raimando 

Dir 

818 Harrison Ave 4th Fl Admin 

Boston MA 02118 

2d 3c 4abc*de*f 6ab 7b i jk 



HI thy Baby Boston Coop Prog 
to Prevent Prematurity 
Diana Raphael RN MS 
Clinical Spec 
Boston Dept Hlth/Hosp 
HO 313 818 Harrison Ave 
Boston MA 02118 
2d 3ab 4abc*e*f* 6bc 7ihm 



Random Controlled Trial to 

Promote Breastfeeding Duration 

Stephen Wirtz 

Proj Dir 

Boston Univ Sch Pub/Hlth 

80 E Concord St 

Boston MA 02118 

2d 3c 4abc* 6c 7ohk 



WIC Prog—South End CHC 

Joanna Douglas 

Sr Nutritionist 

400 Shaumut Ave 

Boston MA 02118 

2d 3c 4abc*e*f* 6bc 7nh 



Parent 6 Child Devel 

Prog 

Vickie Bornas 

PhD 

Brookside Comm Hlth Ctr 

3297 Washington St 

Jamaica Plain MA 02130 

2d 3ab 4abc* 6d 7ahmkpu 

Med East Comm Hlth Plan 

Berni ce K Haml in 

Div Exec Dir 

340 Wood Rd 

Braintree MA 02184 

2d 3c 4abcde 6d 7b 

Parenting Your Child From 1-6 

Early Childhood Hlth 6 Safety 

Margaret Casey 

Dir Nursing/Hlth Svcs 

American Red Cross/MA Bay 

99 Brook 1 ine Ave 

Boston MA 02215 

2c 3b 4abc*e*f* 6d 7kh 



WIC Prog— Cape Cod 

Candida Bowe 

Joanne Taupier 

1 Elm St 

Hyannis MA 02601 

2bcd 3c 4abde 6bc 7nhm 



124 



RESOURCES 



Fall River Prenatal Prog 

G Ann Fitton RD 

Fall River Comm Develop Ctr 

102 Country St 

Fall River MA 02723 

2b 3c ^abce*f* 6b 7ihm 



WIC Prog—Prince Georges 
Cty Hlth Dept 
Beatrice L Pickett 
93 lit Piscataway Rd 
Clinton MD 20735 
2d 3c 4abcde 6bc 7nh 



Black Adolescent Group 

Lesl ie Morri s 

MSW MPH 

303 W Chesapeake Avenue 

Towson MD 21 20** 

2c 3a *»a 6d 7akv 



Pregnant 6 Parenting 

Teens Prog 

Kathleen O'Donnel 1 

Coord 

19 Spring St 

Taunton MA 02780 

2c 3a 4abc*de 6d 7ahimpu 



Hlthy Parent/Healthy Child 

Cathie Morrison 

Coord 

601 Aikins 

Winnipeg MB R2W kJ5 

2d 3c *tabe* 6bc 7bhkmu 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage) s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 
7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Prenatal Clinic 

Irene M Walker 

Staff Nurse-OB Clinic 

1 Hosp Dr 

Cheverly MD 20785 

2c 3c 'tabc* 6bc 7ihu 



Montgomery Cty Dept of Hlth 

Wheaton Hlth Ctr 

Anne Coakleg 

242^ Reedie Dr 

Wheaton MD 20902 

2d 3c i»abc*de* 6d 7chmpu 



Aberdeen Hlth Ctr 
Norma Kirkwood RN 
Hartford Cty Hlth Dept 
3*» N Philadelphia Blvd 
Aberdeen MD 21001 
2d 3c Aabf 6bc 7chu 



Hlthy Mothers/Healthy Babies 
Donna Peterson 
MD Dept Hlth Mental Hygiene 
201 W Preston St 
Baltimore MD 21201 
2bc 3c 4abc 6bc 7bhmu 



Food and Drug Admin 
Anne B Lane 
Pub Hlth Svc 
900 Madison Ave 
Baltimore MD 21201 
2c 3c ^abc 6d 7bhu 



Hlthy Babies/Healthy Mothers 

MD Preterm Labor Prev Subc 

David A Nagey MD PHD 

Univ MD Med Syst/Hosp— 0B/GYN 

22 S Greene St 

Baltimore MD 21201 

2d 3c ^abcde 6b 7it 



Intervention with PACT 

Parents 6 Children Together 

Thomas Stengel 

Exec Dir 

106 E Chase St 

Baltimore MD 21202 

2d 3c ^tabcde 6c 7kt 



Maternity Ctr East 
Jean I Fowler 
503 N Chester St 
Baltimore MD 21205 
2bc 3c 4abd 6abc 7ihmu 



March of Dimes Birth 

Defects Found 

Marianne CI isham 

Reg Prog Coord 

7215 York Rd 

Baltimore MD 21212 

2d 3c *»abc*def 6d 7ihmtu 



Vivian E Washington Residence 
Single Parent Svcs Baltimore 
S E Haus 

Chief Single Parent Svcs 
Rm 300 Metro Plaza 
Baltimore MD 21215 
2c 3a 6c 7av 



Park West Med Ctr 
Allen J Bennett PD MPH 
Tonya Johnson 
3319 W Belvedere Ave 
Baltimore MD 21215 
2bc 3c **ab 6d 7bhimu 



Single Parents Svcs 
Mimi Kraus LCSW 
20** w Lanvale St 
Baltimore MD 21217 
2bc 3b ^ab 6bc 7khku 



Parent-Child Ctr 
Patricia Cassait 
3028 Greenmount Ave 
Baltimore MD 21218 
2d 3c *»ab 6d 7bhmu 



125 



RESOURCES 



Preparation for Parenthood 
Peg S Tot ten 
2701 N Charles St 
Baltimore MD 21218 
2bc 3c 4ab 6bc 7hm 



Johns Hopkins Adolescent 
Pregnancy and Parent Prog 
Rosal ie Streett 
405 N Carol ine St 
Baltimore MD 21231 
2b 3a 4ab 6bcd 7ahjkmuv 



The Johns Hopkins Self Ctr 
Rosal ie Streett 
405 N Carol ine St 
Baltimore MD 21231 
2bc 3a 4a 6a 7j'hmu 



Talbot Cty Hlth Dept 

Maternity Prog 

Al thea A Ewing 

Maternity Coord 

PO Box 480 

Easton MD 21601 

2c 3c 4ab 6d 7chmv 



Worcester Cty Prenatal Clinic 

Martha Freeman CHN 

107 Williams St 

Berlin MD 21811 

2bc 3c 4abc 6bc 7chmu 



WIC Prog--Sacopee Valley 

Hlth Ctr 

Meredith Crain 

Kezar Falls ME 04047 

2d 3c 4b 6d 7nh 



Genesis 

Pat Turner RN 

200 College St 

Lewiston ME 04240 

2c 3a 4b 6bc 7bhmu 



Maine Highway Safety Prog 

Harland L Robinson 

36 Hospital St 

Augusta ME 04330 

2d 3c 6c 7k 



EPSDT/ME Dept Human Svcs 

Edna Jones 

Coord 

Statehouse Sta 1 1 

Augusta ME 04333 

2d 3ab 4bd 6c 7e 



Franklin Square Hosp 
Linda Michel RN 
9000 Frankl in Sq Dr 
Baltimore MD 21237 
2c 3b 4ab 6bc 7k 



Start Right Maternal 6 

Infant Care Prog 

Paula McLel Ian 

Maryland Primary Hlth Care Assn 

132 Holiday Ct Ste 211 

Annapolis MD 21401 

2c 3c 4ab 6d 7bhmu 



Children Don't Come with 

Directions 

Mary Usher RN 

10 Sunset Ave 

B ME 04064 

2d 3c 4d 6c 7k 



Maternal/Infant/Child Hlth Grant 

Mary Ellen Orchenes 

Portland Div Pub Hlth 

389 Congress St 

Portland ME 04101 

2d 3c 4b 6d 7chmu 



Well Child CI inic--Preventi ve 

Dental Prog 

Stacie Beedy RDH BS 

ME Dept Human Svcs 

Off of Dental Hlth StHse Stn 11 

Augusta ME 04333 

2c 3c 4bc*d* 6c 7q 



Sheepscot Valley Hlth Ctr 

Roy Mil ler MD 

Main St 

Coopers Mil Is ME 04341 

2c 3c 4b 6d 71hmos 



Al legany Cty Hlth Dept 

Maternity Intake 

Helen Ruby RN 

Comm Hlth II 

PO Box 1745 

Cumberland MD 21502 

2d 3c 4abcd 6ab 7chmp 



Parenti ng--Prep for Parenthood 

American Red Cross/Portland 

Ann Harriman 

524 Forest Ave 

Portland ME 04101 

2c 3ab 4b 6d 7bah 



Allied Systems Designs 

El len Green 

Hlth Proj Cons 

27 State St 

Bangor ME 04401 

2c 3ab 4abcd 6d 7ahmu 



WIC Prog--Al legany Cty Hlth Dept 

Judy Richmond RN 

PO Box 1745 Willowbrook Rd 

Cumberland MD 21502 

2d 3c 4ab 6d 7nhm 



PROP/WIC Prog 

Shirley Dubuc 

Prog Dir 

145 Newburg St 

Portland ME 04101 

2d 3c 4abe* 6bc 7nhm 



WIC Prog--Penobscot-Pi scatoquis 

ME Dept Hlth/Welfare 

Diana Roak 

103 Texas Ave 

Bangor ME 04401 

2d 3c 4abcde* 6d 7nhmq 



Garrett Cty Hlth Dept 

Improved Pregnancy Outcome 

Sara K Donley BSN 

253 N 4th St 

Oakland MD 21550 

2bc 3c 4bde 6d 7ihmu 



Maternal/Chi Id Hlth Proj 

Comm Hlth Svcs 

Phyl 1 i s Kamin 

Prog Dir 

PO Box 8250 

Portland ME 04104 

2d 3ab 4abe 6d 7chmpt 



WIC Prog--Pleasant Point 

Hlth Ctr 

Judith A R Carpenter 

Pleasant Point Indian Tribe 

Hlth Ctr 

Perry ME 04667 

2c 3ab 4bd* 6d 7nhm 



126 



RESOURCES 



Aroostook Valley Hlth Ctr 
David Lieberman PA-C 
Box 127 

Ashland ME 04732 
2d 3c 4b 6d 7bhm 

Penobscot Bay Med Assoc 
Primary Hlth Care Prog 
Bridget Palmer RN/FNA 
PO Box 608 

Rockland ME 04841 
2d 3c 4b 6d 7bhkm 

Mid-Coast Family Planning 

Mary Bol 1 inger 

Box 866 

Rockland ME 04841 

2d 3c 4b 6d 7jhu 

Hlth Promotion Initiative 

Comm Hlth Ctrs Proj 

Beth Clark RN MS 

Kennebel Valley Reg Hlth Agy 

8 Highwood St Box 728 

Waterville ME 04901 

2c 3c 4b 6d 71 hm 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC Prog — Kennebec Valley 

Comm Action Prog 

Kay Dutram 

101 Water St Box 278 

Waterville ME 04901 

2d 3c 4be 6bc 7nh 



Teen Parent Sch Prog 

Sharon Houghton 

Dir 

Maine Childrens Home 

34 Gi lman St 

Waterville ME 04904 

2c 3ab 4b 6bcd 7ahmu 



Bingham Area Hlth Ctr 
Upper Main St 
Bingham ME 04920 
2c 3b 4b 6c 7kh 



Adolescent Pregnancy Proj/KVCAP 

Barbara Ann Flannery 

50 Water St 

Skowhegan ME 04976 

3ab 4b 6bc 7abhjmpu 



Preparation for Parenthood 

Parenting Your Child 

F Flowers RN 

American Red Cross/SE Ml Chapter 

100 Mack Ave 

Detroit Ml 

3c 4abc* 6d 7hijk 



Area Svc Assn Young Moms 

Therese T McNei 1 

MSW 

45 E Pearl 

Hazel Park Ml 48030 

2c 3ab 4b 6d 7ak 



Macomb Cty Hlth Dept 

Prenatal Care Prog 

Patricia Duthie RN 

Coord 

43545 Elizabeth Rd 

Mt Clemens Ml 48043 

2c 3c 4ab 6ab 7ihm 



Pontiac Infant Hlth Prom Prog 

Oakland Cty Hlth Div 

Betty J Yancey BSN RN 

Coord 

1200 N Telegraph Rd 

Pontiac Ml 48053 

2bc 3c 4abc* 6ab 7ihm 



Prevention of Preterm Labor 
Pontiac Gen Hosp 
Karen A Schornack MSN RN 
Perinatal Nurse Ed 
Seminole at G W Huron 
Pontiac Ml 48053 
2b 3b 4abc 6b 71 t 



Child Passenger Safety 

Eva Clark 

Annex 

12D0 N Telegraph 

Pontiac Ml 48053 

2d 3c 4abc 6bc 7k 



Prenatal Substance Abuse 

Prevention--FAS 

Eva Clark 

Oakland Cty Hlth Div 

1200 N Telegraph 

Pontiac Ml 48053 

3c 4abc 6ab 7m 



Pontiac Teen Mother Prog 

Mar i 1 yn Will iams 

25 St Sanford 

Pontiac Ml 48058 

2c 3a 4abc 6d 7ahmu 



WIC Prog--Oakland Cty 
Deborah McKee 
196 Oakland Ave 
Pontiac Ml 48058 
2c 3c 4abc*de* 6d 7nhv 



St Clair Cty Hlth Dept 

IHIP (I CARE) 

Dorothy Lonsberry 

Dir Nursing 

3415 28th St 

Port Huron Ml 48060 

2d 3c 4ae 6d 7chu 



Catholic Soc Svcs St Clair Cty 

Pregnancy Testing Prog 

Liz Lamb SW 

2601 13th St 

Port Huron Ml 48060 

2c 3c 4abcd 6b 7ihmu 



WIC Prog--St Clair Cty 

Donna Blay 

Coord 

3415 - 28th St 

Port Huron Ml 48060 

2bc 3c 4abcde 6d 7nh 



127 



RESOURCES 



Pregnancy Couns Unit 
Kathleen McGuire ACSW 
Catholic Soc Svcs of OK Cty 
1424 E Eleven Mile Rd 
Royal Oak Ml 48067 
2c 3c 4abc 6d 7ihkv 



Parent- Infant Growth Prog 
Family/Children Svcs Oakland 
Beatrice Rowe 
2351 W 12 Mile Rd 
Berkley Ml 48072 
2c 3c 4abc*d 6bc 7khmu 



Lamaze Childbirth Classes/ 
CSEC Classes 
Nancy A Garavagl ia 
38118 Chatham Ct 
Sterling Hgts Ml 48077 
2bc 3c 4ab 6d 7 ins 



Planned Parenthood 

Mi d-Michigan 

JoAnne Petersm 

Exec Dir 

PO Box 3673 

Ann Arbor Ml 48106 

2bc 3c 4abc*def 6ab 7ju 



Hlth Promotion Pub 
HI th Nursing Svcs 
Margaret A Fox 
Parent/Child Nurse Spec 
Washtenaw Cty Hlth Dept 
4101 Washtenaw 
Ann Arbor Ml 48107 
3c 4abcef 6d 7chmu 



Parent-Infant Prog 
Michael Mulvihill MSW 
Downriver Guidance Clinic 
2959 Biddle 

Wyandotte Ml 48192 
2c 3c 4ab 6bc 7bk 



School -Age Parent Prog 

Carole Rycus 

Ypsilanti HS 

2095 Packard 

Ypsilanti Ml 48197 

2bcd 3a 4ab 6bc 7ahmu 



Chi ldren's Ctr 

Colleen Reed MSW CSW 

Wayrre Cty TeenAge Parent Prog 

101 E Alexandria 

Detroit Ml 48201 

2c 3ab 4ab 6d 7ahu 



Hutzel Hosp Substance Abuse 

Prog for Women 

Barbara Fields 

Clinic Dir 

4827 Brush 

Detroit Ml 48201 

2d 3c 4ab 6d 7m 



Sacred Heart Womens Day 

Treatment Ctr 

Sonia J Archer 

Dir 

2230 Witherell YWCA Bldg 6th Fl 

Detroit Ml 48201 

2d 3c 4abcd 6d 7mm 



Facilitating Teen Parents Pre- 
mature Infant Interaction 
Lois 0_uic ACSW 
St John Hosp 
22101 Moross Rd 
Detroit Ml 48236 
2c 3a 4ab 6c 7ak 



Lapeer Cty Crippled Children's 

Prog 6 MCH 

Pat Crawford RN 

Lapeer Cty Hlth Dept 

1575 Suncrest Dr 

Lapeer Ml 48446 

2c 3c 4abc* 6d 7chik 



Special Delivery Prog 

St Joseph Hosp 

Hellen Harley RN MS 

302 Kensington 

Funt Ml 48502 

2d 3c 4abcdef 6d 71 jk 



Pregnancy Outreach Prog 

March of Dimes 

Sharon Kennedy 

Coord 

609 W Court St 

Flint Ml 48503 

2c 3ab 4abc 6b 7i lhu 



Saginaw Cty Dept Pub Hlth 
Maternal/Infant Care Prog 
Joyce Rouse 
1600 N Michigan Ave 
Saginaw Ml 48602 
2d 3c 4abcde 6bc 7chmuv 



Infant Research Lab Childrens 

Psychiatric Hosp 

Thomas M Horner PHD 

3021 CPH Univ Ml 

Ann Arbor Ml 48109-0010 

2d 3c 4abcde 6c 7k 



Fami 1 y Pract i ce Ctr 
Chandice C Harris RN MSN 
775 S Main St 
Chelsea Ml 48118 
2c 3c 4ab 6d 7bhmuv 



Riverside Hosp Prenatal Classes 

B O'Lynnger RN 

OB Head Nurse 

4401 Rox Ct 

Trenton Ml 48183 

2c 3c 4b 6bc 7ihu 



Detroit Dept Hlth 

Eastside Hlth Ctr 

Ruth Johnson 

Nutr i t ioni st 

7900 Kercheval 

Detroit Ml 48214 

3c 4abf 6d 7chmu 



Detroit Maternity 6 Infant 

Care Proj 

Annie L Thomas 

Nutri tionist 

Detroi t Mem Hosp 

1420 S Antoine 

Detroit Ml 48226 

2c 3c 4abc*de 6c 7hhmtu 



Group Hlth Svc of Ml 
4200 Fashion Square Blvd 
Saginaw Ml 48603 
2d 3c 4abc* 6b 7m 



N Ml Hlth Svcs 

Gayle Wi 1 lett RN 

Patient Ed/Advocate 

PO Box 785 

Houghton Lake Ml 48629-0785 

2c 3c 4b 6bc 7ih 



128 



RESOURCES 



STAR (Svcs to Teens at Risk! 

Jan Crozier RN 

125 W Main St 

Midland Ml 48640 

3a 4abcdef 6b 7ahjkmu 

Sterling Area HI th Proj 

Roger J Rush low 

Exec D i r 

725 E State St 

Sterling Ml -48659 

2d 3c 4b 6d 71hmu 

Infant Hlth Initiative 
Oist Hlth Dept 3 
Jeannine Denton RN BSN 
806 W Houghton Ave 
West Branch Ml 48661 
2d 3c 4b 6bc 7ckhm 

Bay-Arenac Interm Sch Dist 

Spec Ed Svcs Pregnant Teens 

Norma Gravl in RN PNP 

Proj Coord 

4228 2 Mile Rd 

Bay Cy Ml 48706 

2bc 3c 4abcd 6bc 7ahmu 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 



Age(s) 










3a 


- Teenager 










3 b 


• Young adult 


and 


older 


adult 


3c 


Both 










Ethnic group(s) 










4a 


- Black 










4b 
4c 


■ White 
Hispanic 










4d 


- Native American 








4e 


Asian/Pacific 


Islander 






4f- 


Other 











Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j~ Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 
7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Lutheran Child/Family Svc 

of Ml 

Clarence D Fischer 

Dir Pro Svcs 

PO Box B 522 N Madison 

Bay Cy Ml 48707 

2d 3c 4ab 6bc 7ihmu 



PAIR Perinatal Prog 

Kim Barnas 

503 N State 

Alma Ml 48801 

2d 3c 4bc 6bc 7kbhimv 



Ctr for Study of Infants 6 

Thei r Fami 1 ies 

Michael Trout 

Dir 

503 N State 

Alma Ml 48801 

2d 3c 4abcd 6bc 7khk 



Prenatal Postpartum Care 

Barry Eaton Dist Hlth Dept 

Pamela Groner 

528 Beech St 

Charlotte Ml 48813 

2c 3ab 4abc 6ab 7ik 



Perinatal Positive Parenting 
Robert Boger MD 
Inst Family & Chi Id Study 
HMH Unit 2 Coll Human Ecology 
E Lansing Ml 48824-1030 
2c 3c 4ab 6bc 7k 



Sch Age Parent Prog 
Livingston Cty Hlth Dept 
210 S Highlander Way 
Howell Ml 48843 
2s 3ab 4abcde 6be 7abhmuv 



Ionia Cty Expectant Parents Prog 

Bonnie Gal loway RN 

479 Lafayette St 

Ionia Ml 48846 

2c 3ab 4bcd 6bc 7ih 



Prenatal/Postpartum Care 

Mid-MI Dist Hlth Dept 

Bonnie Joyal RN C 

Coord 

601 N State Rd 

Stanton Ml 48888 

2d 3c 4abcdef 6bc 7ihmtu 



Jean Granger Prenatal Clinic 

Sheila Dubenion-Smi th 

306 W Willow 

Lansing Ml 48906 

2d 3ab 4abcdef 6bc 7ihmu 



Cristo Rey Adolescent 

Parenthood Prog 

Mary Gray 

Mid-Michigan Amer Red Cross 

PO Box 30101 

Lansing Ml 48909 

2c 3ab 4abc 6c 7akhm 



Michigan Dept of Social Svcs 

Stanley Stewart 

300 S Capitol 

Lansing Ml 48909 

3a 4abc*df 6d 7ahmu 



WIC Prog--lngham Cty Hlth Dept 

Esther Potestpark 

5303 S Cedar 

Lansing Ml 48909 

2b 3b 4abc*de*f 6d 7nh 



Kalamazoo Cty Head Start 
Patty Mais 
201 W Kalamazoo Ave 
Kalamazoo Ml 49007 
2d 3c 4abce 7kh 



Every Child a Wanted Child- 
Planned Parenthood 
Louise D Safron 
Exec Dir 

4201 W Michigan Ave 
Kalamazoo Ml 49007 
2d 3c 4abce* 6d 7ju 



WIC/Nutrition Bur 
Kalamazoo Cty Pub Hlth Div 
Nancy Servoss RD 
4 18 W Kalamazoo Ave 
Kalamazoo Ml 49007- 
3c 4abc*def 6d 7nh 



MARCHA 

Jame Mil ler RN 

Box 130 

Bangor Ml 49013 

2d 3c 4abc* 6d 71 



129 



RESOURCES 



Expectant Parents Classes 
Pre-Natal Clinic 
Virginia Benedict 
Barry-Eaton Hlth Dept 
110 W Ctr St 

Hastings Ml 49058 
2c 3b 4b 6d 7i 



Maternal Child Hlth Prog 
Suzanne Carl RN 
Jackson Cty Hlth Dept 
410 Erie St 

Jackson Ml 49202 
2d 3a 4abcdef 6d 7abhi 



Detroit Hlth Dept--Hlth Ed 
Risk Reduction Prog 
Larry Lockridge MD MPH 
1151 Taylor 

Detroit Ml 49202 
3ab 4abcd 6b 7m 



WIC Prog--Lenawee Cty 

Frances Ph i 1 1 i ps 

848 Hoch Ave 

Adrian Ml 49221 

2d 3c 4abc*de*f* 6d 7nhmp 



Family Learning Ctr Sch 

Age Parent Prog 

Jean L Ekins 

Lesl ie Publ ic Schs 

400 Kimbal 1 St 

LLeslie Ml 49251 

2d 3ab 4abcd 6d 7ahmuv 



Holland-West Ottawa-Saugatuck 

Comm Educ 

Jan Dalman 

Ctr for Comm Educ 

96 w 15th 

Holland Ml 49423 

2c 3ab 4abce 6d 7ahmu 

ASSIST (Antepartum Support Svcs 

Ottawa Cty Hlth Dept 

Sharon VanPutten 

RN ASSIST Prog Coord 

323 N River Ave 

Holland Ml 49423 

2d 3c 4bc 6be 7ihm 



Muskegon Cty Hlth Dept 

B Joseph RN 

Dir of Nursing 

1611 E Oak 

Muskegon Ml 49442 

2d 3c 4abc*def 6d 7chmu 



Male Involvement Prog 

Steven L Creamer 

Planned Parenthood of W Ml 

425 Cherry SE 

Grand Rapids Ml 49503 

2d 3c 4abcdef 6d 7j 

Planned Parenthood Ctrs of W Ml 

Suzy Reiter RNC 

425 Cherry SE 

Grand Rapids Ml 49503 

2d 3c 4abcdef* 6ab 7jhmu 

Blodgett Hosp Expectant 

Parent Educ Prog 

Pat Krauser RPT EPE 

Superv 

Blodgett Mem Med Ctr 

1840 Wealthy SE 

Grand Rapids Ml 49506 

2c 3c 6bc 7bhi 

NW Ml Hlth Svcs 
Migrant Hlth Prog 
Willa E Hayes RN 
Dir Nursing Svcs 
10767 Traverse Hwy Ste B 
Traverse City Ml 49684 
2d 3c 4abc*df* 6d 71 h 

Teenage Parent Prog 
Evelyn Debebe 
Child/Family Svcs of Ml 
1044 US 23 N 

Alpena Ml 49707 
2c 3ab 4b 6d 7ah 



Perinatal Educ 

Marie Nadeau RN 

Alpena Gen Hosp 

1501 W Chisholm 

Alpena Ml 49707 

2c 3c 4b 6b 7bhm 

TELSTAR--Rural Prog for 

Handicapped Children 0-5 

Gail Authier 

Preschool Cons 

Alpena-Montgomery-Alcona Sch Dis 

1691 M32 W 

Alpena Ml 49707 

2d 3c 4b 6c 71 v 



Char-Em Alternative Prog for 

School -Age Parents 

Mary Biagini 

Coord/Teacher 

Mercer Blvd 

Charlevoix Ml 49720 

2d 3ab 4bdf 6d 7abhmpv 



Thunder Bay Comm Hlth Ctr 

Prenatal Care/Expec Parent Class 

Ruth Ziel RN BSN 

610 Caring St 

Hillman Ml 49746 

2bc 3c 4b 6bc 7ihm 



Sch for Adolescent Parents 
Patricia Smith RN 
Dist Hlth Dept #3 
2233 Mitchell Ct 
Petoskey Ml 49770 
2c 3a 4bd 6d 7ahmiku 



Dist Hlth Dept 3 
Bert Notestine - Hlth Educ 
2233 Mitchell Ct 
Petoslay Ml 49770 
2d 3c 4bde 6d 7bhu 



Pregnancy Svcs of Marquette 

Linda Kearney 

Dir 

347 Rock St 

Marquette Ml 49855 

2c 3c 4abd 6ab 7iju 



WIC Prog--Multi-Cty Nursing Svc 
Moninia S Oliveros RD 
Box 701 Hwy 34 E 
Detroit Lakes Ml 56501 
2c 3c 4abcde* 6bc 7nhmo 



EFNEP--Col 1 Micronesia 

Coop Ext Svc 

Enid McKay 

US Dept Agric 

Box 1015 

Majuro Ml 96960 

2b 3c 4e* 6d 7dh 



Expectant Parent Classes 

Hinckley Area Clinic 

Merry Marks 

PO Box 280 

Hinckley MN 55037 

2c 3b 4b 6b 7ih 



St Paul Maternal/Infant Care 

Proj/Adol escent Svcs Proj 

Ann Ricketts 

640 Jackson St 

St Paul MN 55101 

2c 3a 4abc*de* 6d 7abhmu 



130 



RESOURCES 



YMCA of the USA 

You & Me Baby 

Susan Regnier 

19^ E 6th St 

St Paul MN 55101 

2c 3c 4abcde* 6bc 7bnhm 



Lincoln House Childrens 

Home Soc MN 

Mary Lou Gladhil 1 

2230 Como Ave 

St Paul MN 55108 

2bc 3ab 4abd 6bc 7khmv 



WIC Prog--Winona Cty Pub HI th 

Nursing Svc 

Jane M Starnes 

WIC Coord 

Courthouse 

Winona MN 55987 

2c 3ab 4abcde* 6d 7nh 



Childnet: Making Connections 

for Minnesotas Children 

Andrea Christianson 

Proj Dir 

906 N Dale 

St Paul MN 55103 

6c 7kh 



Fami ly Tree 

Trish Booth 

1599 Selby Ave 

St Paul MN 55104 

2c 3c 4b 6ab 7bhmou 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c • 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a • Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d- All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m • Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Foster Care & Med Svcs 

June Wheeler PHN 

MN Childrens Home Soc 

2230 Como Ave 

St Paul MN 55108 

2c 3ab 4abcd 6d 7kh 



Minneapolis Hlth Dept Maternal 

and Child Hlth Prog 

Karen Knol 1 

Prog Mgr 

250 S 4th St 

Minneapolis MN 55415 

2d 3c 4abc*de* 6d 7chku 



Dental Hlth Prog 

MN Dept of Hlth 

Richard J Hastreiter DDS MPH 

Dental Hlth Dir 

717 Delaware St SE 

Minneapolis MN 55440 



Seton Prog Catholic Charities 

Minneapol is St Paul 

Karen Ravenhorst 

18015 33rd Ave 

Plymouth MN 55447 

2c 3ab 4ab 6bc 7ihm 



Koochiching Itasca Action Counc 

WIC Proj 

Wendy Anderson RD 

WIC Proj Dir 

PO Box 828 

Grand Rapids MN 55744 

2b 3c 4bd 6d 7nhm 



Pi lot Parents of NE MN 

Lynne Frigaard 

Dir 

201 Ordean Bldg 

Duluth MN 55802 

3c 4abcdef 6c 7kv 



Prenatal Classes for Cambodians 

Barbara Huus 

Olmstead Cty Hlth Dept 

415 4 St SE 

Rochester MN 55904 

2b 4e* 6bc 7ijh 



American Red Cross/Winman Cty 

Lynn Theuren 

498 Kerry Ct 

Winona MN 55987 

2c 3c 4b 6bc 7h 



WIC Prog--MN Valley Action Coun 

Carla Peterson 

410 Jackson St 3rd Fl Nichol Ctr 

Mankato MN 56001 

3ab 4abcdef 6d 7nhm 



La Leche of MN 

Kathy Westerman 

103 Inner Dr 

Montgomery MN 56069 

2d 3c 4bf* 6d 7ohk 



Maternal/Child Hlth Prog 

Brown/Nicol let Cty 

Linda Kluever PHN 

Nicollet Cty Pub Hlth Nurs Svc 

Courthouse Box 73 

St Peter MN 56082 

2d 3c 4abcde 6bc 7bh 



Countryside Pub Hlth Svc 

Laurie Dieken PHN 

Courthouse 

Granite Falls MN 56241 

2c 3c 4bd 6bc 7chm 



Lyon County Comm Nursing Svc 

Michelle Malmquist 

Lyon Cty Courthouse 

607 W Main 

Marshall MN 56258 

2c 3ab 4b 6d 7bhnu 



Class 

Immunization Clinics 
Nancy Alsase PHN 
Countryside Pub Hlth Svc 
Chippewa Cty Courthouse 
Montevideo MN 56265 
3c 4bc*e 6d 7chkm 



131 



RESOURCES 



Expectant Parent Class 

Barbara Carlson PHN 

Stevens Cty Pub HI th Nursing 

Box 404 

Morris MN 56267 

2c 3ab 4abd 6bc 7bhmu 



4-Cty EPS/WIC 

Ruth Nepper 

Courthouse 

Warren MN 56762 

2d 3c 4abc*de*f 6d 7nhm 



La Leche League — St Louis Mo/WIC 

Marene Olwig 

2782 Irondale 

St Louis MO 63129 

3ab 4a 6bc 7no 



WIC Prog--Todd Cty Pub Hlth Prog 

119 3rd St S 

Long Prairie MN 56347 

2c 3c 4abe 6bc 7nh 



WIC Prog--Tri-Cty Action Prog 

Mary Clare Rieschl 

WIC Prog Dir 

728 S Benton Or 

Sauk Rapids MN 56379 

2c 3b 4abc*de* 6bc 7nhmq 



Post-Partum Phone Call Follow-UP High-Risk Infant Fol low-Up Prog 

Christian Hosp NW Gracie Hutchinson 

Cynthia Bernard CNM 7305 Manchester 

1225 Graham St Louis MO 63143 

Florissant MO 63031 2d 3c 4abcde 6c 7kt 

2c 3c 4abe 6c 7k 



St Louis Cty Dept Comm Hlth 
Lourdus Santos-Pardo MD 
801 S Brentwood 
Clayton MO 63105 
2d 3c 4abce 6d 7chmu 



NEMO Area Prenatal Prog 
Adair Cty Hlth Dept 
Adair Cty Courthouse 
Kirksville MO 63501 
2c 3c 4abe 6b 7chmu 



WIC Prog--Wadena Cty 

Mary M Peterson 

415 S Jefferson - Courthouse 

Wadena MN 56482 

2d 3c 4abc*de* 6d 7nhm 



WIC Prog--OtterTail Cty 

Dept Hlth 

Florence Guse LPN 

Court House 

Fergus Falls MN 56537 

2d 3c 4bde* 6bc 7nhm 

Fami ly Ping 

Roberta Vorderbruggen 

Box L 

New York Mills MN 56567 

2b 3c 4b 6ac 7ju 



WIC Prog--Beltrami Cty 
Edith Ann Jessen RN 
815 W 15th St 
Bemidji MN 56601 
2c 3c 4bde 6d 7nhm 

WIC Prog — Tri-Valley Opportunity 

Counc 

Darleen Mushel RN 

109 S Main 

Crookston MN 5671 6 

2c 3ab 4bc 6bc 7nh 

Quin Cty Maternal/Child Hlth 

Special Prog 
Viola Rud 
Box 248 

Newf olden MN 56738 
2b 3c 4bcd 6d 7k 



Hlth Promotion/Disease 

Prevention Prog 

Paula W Stewart 

Yeatman/Union-Sarah Hlth Ctr 

2730 N Grand Ave 

St. Louis MO 63 106 

2c 3c 3ab 6bc 7abh 



Preparation for Parenthood 

American Red Cross/St Louis 

Maragaret Wichard 

4050 Lindell 

St Louis MO 63108 

2c 3c 4abce 6bc 7bh 



Primary Care Counc — Hlth 
Care Referral Hotline 
Janice Vespa 

Primary Care Concil/St Louis 
4900 Delmar Blvd 4th Fl 
St Louis MO 63108 
2d 3c 4abcdef 6d 7b 



Maternal Hlth Prog 

Erin L O'Reilly RN 

Family Care Ctr of Carondolet 

6313 Michigan 

St Louis MO 63111 

2c 3b 4b 6bc 7bhim 



Uni v MO St Louis 

Sch of Nursing 

Janice M Spikes RN PHD 

8001 Natural Bridge Rd 

St Louis MO 63121 

2c 3ab 4ab 6d 7bhikm 



WIC Child Hlth Conf--Prenatal 
Ste Genevieve Cty Hlth Dept 
Lois M Doherty RN CHN III 
PO Box 49 

Ste Genevieve MO 63670 
2c 3c 4b 6d 7nh 



WIC Prog--Stoddard Cty 

Judi Wi 1 1 iams 

Rt 4 Box 189A 

Dexter MO 63841 

2d 3c 4abd 6bc 7nhm 

WIC Prog—Pemiscot Cty 
Diana Koenning MPH RD 
PO Drawer B 

Hayti MO 63851 
2d 3ab 4ab 6bc 7nh 

Prepared Childbirth Classes 

Doctors Reg Med Ctr 

Pam LaFountain RN 

621 Pine 

Poplar Bluff MO 63901 

2bc 3c 4ab 6bc 7ihm 



Hlthy Parents Healthy 
Children Parenting Classes 
Janice Sortwel 1 RN BSN 
Cy of Independence 
223 N Memorial Dr 
Independence MO 64050 
2d 3c 4abcde 6d 7kh 



Hil Itop Sch 

Suzanne F Huff 

3400 N Lee's Summit Rd 

Lee's Summit MO 64063 

2d 3a 4abc 6d 7amhu 



132 



RESOURCES 



Johnson Cty Comm Hlth Svcs 
Judy Schache RN 
601 E Jay St 

Warrensburg MO 64093 
2d 3c 4abcf 6d 7chk 

YWCA Parenting Ed Proj 

Anita Shekinah 

Proj Dir 

YWCA of Kansas Cty 

1000 Charlotte St 

Kansas City MO 64106 

3ab 4abc 6c 7ahk 



American Red Cross/KS Cy Chapter 

Preparation for Parenthood 

Carol Frost 

3521 Broadway 

Kansas City MO 64111 

2c 3b 4abc 6bc 7kbh 



WIC Prog— TMC East 

Sue Carey 

Little Blue & Lees Summit Rd 

Kansas Cy MO 64139 

2c 3ab 4abc 6d 7nh 



WIC Prog — Cooper Cty Nursing Svc 

CHC Family Ping 

Trudi Fahrenbrink RN CHN II 

Courthouse 

Boonville MO 65233 

2c 3ab 4abd 6d 7nhmu 



Chi Id Hlth Conference 
Chariton Cty Nursing Svc 
J Kussman RN 
Courthouse 

Keytesville MO 65261 
2d 3b 4ab 6c 7kh 



St Maries Family Med Ctr 
Mai 11a D Staker RN 
2900 Baltimore 
Kansas Cy MO 64108 
2c 3c 4abc 6d 7 i k 

Pregnancy Lifestyle Profile 

Kansas Cy MO Hlth Dept 

Phyl lis Miller 

1423 E Linwood 

Kansas City MO 64109 

2bc 3ab 4abc 6b 7ihmv 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d • EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Kay Cee am La Leche League 

Kathleen Kiser 

Leader 

8110 N London Or 

Kansas City MO 64151. 

2ac 3c 4abce* 6bc 7ohk 



WIC Prog — St Joseph-Buchanan 

Cty Hlth Dept 

Jerry McDonald 

Nutri tioni st 

904 S 10th St 

St Joseph MO 64503 

2c 3ab 4abc 6bc 7nh 



Daviess Cty Hlth 

Prenatal Clinic 

Val letta Dannul 1 RN 

Courthouse 

Gallatin MO 64640 

2c 3c 4b 6bc 71 hm 



WIC Prog 

Suzanne Woodord 

513 Kentucky 

Joplin MO 64801 

2d 3c 4abcde* 6bc 7nhkq 



Prevention for Mental 

Retardation MO Div of Hlth 

Annette M Kobriger 

1730 E Elm St 

Jefferson Cy MO 65101 

3c 4abe 6bc 7h 



Prenatal Letter Prog 

MO Div Hlth Dept Soc Svcs 

Glenda Hamilton MS MSPH 

PO Box 570 

Jefferson Cy MO 65102 

2bc 6ac 4abcdef 6bc 7ih 



High Risk Fol low-Up 

Benton Cty Hlth Dept 

Mari lyn Ryan RN 

PO Box 935 

Warsaw MO 65355 

2c 3ab 4bc* 6c 7kh 



Prenatal & Expectant Parent 

Benton Cty Hlth Dept 

Rebecca Lynn RN CHN III 

Admin 

PO Box 935 

Warsaw M0 65355 

2d 3c 4abcde 6bc 7iht 



WIC Prog—Dent Cty Hlth Ctr 

Cty Hlth Ctr Prenatal Class 

Carol Plank 

501 S McArthur 

Salem MO 65560 

2c 3c 4b 6bc 7nh 



Dal las Cty Hlth Dept 

Dolores Henderson 

Admin 

PO Box 3k 

Buffalo MO 65622 

2c 3c 4b 6d 7ch 



Home Vi si tor Prog 

Mary Nau 

Springfield Greene Cty Hlth Ctr 

227 E Chestnut Expy 

Springfield MO 65802 

2d 3c 4abe 6c 7kh 



Comm Hlth Svcs 

Linda Dowdy RN 

Dir 

American Red Cross 

1730 E Portland 

Springfield MO 65804 

2d 3ab 4ab 6bc 7ihkmu 



133 



RESOURCES 



Springfield-Greene Cty 
Maternal/Child Hlth 
Annabel le Masberry 
227 E Chestnut Expy 
Springfield MO 65807 
2d 3c 4abe 6d 7chmu 



Tippa Cty Hlth Dept 
116 W 1st St 

Ripley MS 38663 
2c 3ab 4ab 6b 7ch 



MS St Dept of Hlth 

NE Pub Hlth Dist I I 

Box 199 

Tupelo MS 38802-0199 

2d 3c 4abcd 6d 7cahuv 



Jefferson Comp Hlth Ctr 

Thai s Frankl in 

Nutri tioni st 

Box 98 

Fayette MS 39069 

2c 3c 4ab 6d 7nhjmu 



S Ctr MS Rural Hlth Assn 
Tri-Cty Comm Hlth Ctr 
Box 28 

New Hebron MS 391 1 *0 
2d 3c 4ab 6d 71hmt 



Adolescent Pregnancy Task Force 

Linda Ross Aldy 

Governor's Comm Children 6 Youth 

802 N State St 

Jackson MS 39201 

2d 3a 4abcdef 6d 7a 



S Jackson Hlth Dept Clinic 

Gen Feyen CNM 

Cy Jackson Cty Hinds Hlth Dept 

1312 Jones Ave 

Jackson MS 39204 

2d 3c 4abe 6d 7chmu 



Crestview — Crittenton Ctr for 

Mothers 6 Chi 1 dren 

Christopher M. Cherney 

MS Children's Home Society 

PO Box 1078 

Jackson MS 39205 

2c 3a 4ab 6d 7a 



Mississippi Prenatal 

Awareness Proj 

Judy Barber 

MS Dept of Hlth 

PO Box 1700 

Jackson MS 39205 

2d 3c 4ab 6d 7cv 



Adolescent Hlth Ed 

Jane Stanton 

Hlth Educ 

Hinds Cty Hlth Dept 

PO Box 368 

Jackson MS 39205-0368 

2d 3c 4ab 6abc 7ahju 



WIC Prog--MS Dept Hlth 

Kathy B Knight 

Nutrition Ed Spec 

2906 N State St Dale Bldg #501 

Jackson MS 39216 

2d 3c 4ab 6d 7nh 



Coastal Family Hlth Ctr 

Kathryn M Shanks 

Dir 

PO Box *»75 

Biloxi MS 39533 

2d 3c 4abc* 6d 7b 



Coop Ext Svc MS St Univ 
US Dept Agriculture 
P.O. Box 5405 
Miss State MS 39762 
2c 3c 4ab 6c 7k 



Big Horn Cty Hlth Dept 

Dol ly D Lind 

809 Custer 

Hardin MT 59034 

2c 3ab 4bd 6d 7chm 



Lame Deer Clinic Comm Hlth 
Nursing Prog 
Mary M Dodson 
US Pub Hlth Svc 
DHHS Indian Hlth Ctr 
Lame Deer MT 59043 
2d 3c 4d 6d 7ghmtu 



WIC Prog — N Cheyenne 

Comm Hlth Ctr 

Sue Ormond RD 

US Pub Hlth Svc 

Lame Deer MT 59043 

2bc 3ab 4d 6bc 7nhm 



Prenatal Clinic 

Linda M Smith RD MPH 

PO Box AD 

Lodge Grass MT 59050 

2c 3c 4bd 6d 7gh 



WIC Prog--Crow Reservation 
JoAnn Hoi land RD 
Lodge Grass Hlth Clinic 
Lodge Grass MT 59050 
2c 3c 4bd* 6bc 7nh 



Young Families Prog 

Michele Konzen 

Dir 

1721 Lewis Ave 

Billings MT 59102 

2ac 3ab 4bc 6d 7ahkmu 



MT Ctr for Handicapped Children 

Michael Hagen MD 

E MT College 

1500 N 30th 

Billings MT 59105 

2bc 3c 4abcd 6c 7hv 



WIC Prog--Val ley/Phi Hips Cty 

FM Deaconess Hosp 

Janet Aumann RD 

621 3rd St 

Glasgow MT 59230 

2c 3c 4bd 6d 7nhm 

Maternal/Child Hlth 
Custer Cty Hlth Dept 
Courthouse Annex 
Miles Cy MT 59301 
2c 3c 4b 6c 7khu 

Dawson Cty Hlth Dept 

Jeanne Seiferf RN 

205 W Bell 

Glendive MT 59330 

2c 3c 4a 6bc 7chm 

Prenatal Classes 

Teton Med Ctr 

Jane Hartman 

Box 279 

Choteau MT 59422 

2c 3c 4bd 6bc 7ihm 

Helena Sch Dist #1 

Loretta Carter RN 

Sch Nurse 

105 Fairway Dr 

Helena MT 59601 

2c 3ab 4bcd 6bc 7ahmu 



134 



RESOURCES 



Tri Cty Family Ping 
Ruth Gardner 
201 S Main Rm 218 
Helena MT 59601 
2c 3c 4bd 6a 7jhu 



MT Advocacy Prog 

Oevel Disabi 1 i ties 

Kristin Bakula 

Exec i r 

1219 8th Ave 

Helena MT 59601 



Smoking & Pregnancy Prog 

American Lung Assn/MT 

Anna Jones 

Prog Cons 

825 Helena Ave 

Helena MT 59601 

2bc 3c 4abcdef 6d 7m 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f- Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d • EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Shodair Childrens Hosp Dept 

Med Genetics 

Joan Fitzgerald MS 

Genetic Couns 

Box 5539 

Helena MT 59604 

2d 3c 4abcde 6d 7bmr 



Comm Hlth Nursing 

Maxine Ferguson RN MN 

Chief Nursing Bur 

Mt Dept of Hlth & Env Sci 

Cogswell Bldg 

Helena MT 59620 

2d 3c 4bd 6d 7bhmu 



Montana Perinatal Prog 
Donald E Espel in MD 
MT Dept Hlth/Env Sci 
Cogswel 1 Bldg 
Helena MT 59620 
2d 3c 4bd 6d 7bhmu 



Dental Hlth Promotion MT Dept 
Hlth/Environ Sci 
Wi 1 1 iam G Haggberg 
Chief-Dental/Hlth Educ Bur 
C303 Cogswell Bldg 
Helena MT 59620 
2d 3c 4bd 6d 7q 



WIC Prog--MT 

David L Thomas 

WIC Prog Coord 

MT Dept Hlth/Environ Sci 

Cogswel 1 Bldg 

Helena MT 59620 

2d 3c 4abc*d*e*f 6d 7nh 



WIC-Parenting Classes — Gallatin 

Cty Hlth Dept 

Jackie Stonnebe 

Courthouse Rm 103 

Bozeman MT 59715 

2d 3c 4bde 6d 7nho 



Fetal Alcohol Research Prog 
MT St Univ Vet Sci Dept 
Bozeman MT 59717 
3c 4d 6bc 7m 



EFNEP— MT St Univ Coop Ext Svc 

Ruth Lonone 

US Dept Agric 

Taylor Hall MSU 

Bozeman MT 59717 

2b 3b 4abcdef 6d 7dh 



Beaverhead-Madi son 

Chemical Dependency Fac 

Merl in Greenf iel d 

Cty Courthouse 

Dillon MT 59720 

2c 3c 4bd 6d 7m 



WIC Prog--Flathead Reservation 

Patricia A Doran MPH RD 

US Pub Hlth Svc 

26 Round Butte Rd W 

Ronan MT 59864 

2ac~3c 4bd 6d 7nhmo 



WIC Prog — Lincoln Cty/Eureka 

Jean Willi ams 

Box 403 

Eureka MT 59917 

2c 3c 4b 6d 7nhm 



Childbirth Information Assoc 
Linda Baziuk AAHCC IH 
Rt 3 Box 304 

Yadkinville NC 27055 
2d 3c 4abc*d 6d 7ahmuv 



Maternal/Child Hlth and WIC 

Yadkin Cty Hlth Dept 

PO Box 457 

Yadkinville NC 27055. 

2d 3c 4abc* 6d 7nhmu 

OCCHS (Orange-Chatham Comp 

Hlth Svcs) & Prospect Hill Cine 

Joann Hoggerty 

Prospect Hill NC 27324 

2d 3c 4abc* 6d 7h 

Agricultural Extension Prog 

Wi Ida Wade 

Proj Coord 

PO Box 21928 

Greensboro NC 27420 

2bc 3a 4abcde 6bc 7ahm 

Preconceptional Hlth Promotion 
Univ NC OB/GYN Dept 
Merry-K Moos FNP MPH 
214 MacNider Bldg 202H 
Chapel Hill NC 27514 
2c 3c 4abcde 6a 7j'hmu 



Parenting Classes 

Harnett Cty Hlth Dept 

Gloria Thomas 

Main St 

Lillington NC 27546 

2b 3b 4abc 6d 7kh 



135 



RESOURCES 



Boone Trai 1 Med Ctr 
John L Briggs MD 
Drawer B Hwy 421 
Mamers NC 27552 
2c 3ab 4ab 6d 7bh 



Orange-Chatham Comp 

Hlth Svcs 

T M Miller MD 

PO Box 319 

Moncure NC 27559 

2bc 3c 4ab 6d 7bhmu 



Johnston Cty Hlth Ctr 
Maternity Clinic 
Cathy Howes RN 
Smithfield NC 27577 
2d 3c 4abc* 6bc 7chimtu 



Wake Cty Hlth Dept 

Maternal Hlth Prog 

Mary E Stevens RN FPNP 

Wake Cty Hlth Dept 

PO Box 9^9 

Raleigh NC 27602 

2d 3c 4abce 6d 7cht 



Family 6 Child Develop Prog 
3007 N Main St 
Tarboro NC 27886 
2d 3c 4abc 6d 7bhmp 



Child Hlth 

American Red Cross/Martin Cty 

Penny Cowan RN 

PO Box 546 

Williamston NC 27892 

2bc 3ab 4abc 6c 7kh 



Prenatal Care 

American Red Cross/Martin Cty 

Kittie Davis RN 

PO Box 546 

Williamston NC 27892 

2bc 3b 4ab 6bc 71 h 



High Risk/Low Risk 

Maternal Educ 

Vickie Brooks 

Union Cty Hlth Dept 

PO Box 1139 

Monroe NC 28110 

2bc 3c 4ab 6b 7chm 



WIC Prog — Lenoir Cty 

Kathy Tucker 

WIC Dir 

201 N McLewean St 

Kinston NC 28501 

2d 3c 4abc*d 6d 7nho 



Onslow Cty Hlth Dept Prenatal 

Prog 

Ann Cat i no RN 

612 College St 

Jacksonville NC 28540 

2c 3ab 4abcde* 6ab 7chiu 



WIC Prog — Onslow Cty 
Phyl 1 is M Woodson 
612 College St 
Jacksonville NC 28540 
2c 3ab 4abc*de 6bc 7nhm 



Materni ty 

Greene Cty Hlth Dept 

Mary Taylor 

106 Hines St 

Snow Hill NC 2858O 

2bc 3ab 4ab 6ab 7ihu 



NC Medicaid 

Barbara D Matula 

Dir 

410 N Boylan Ave 

Raleigh NC 27603 

2d 3c 4abcdef 6d 7eh 



Scotland Cty Hlth Dept 

M Hambright RN 

PO Box 69 

Laurinburg NC 28352 

2d 3c 4abcde 6d 7cahmuv 



Catawba Cty Hlth Dept 

(MCH Svcs) 

Janice B Kleva RH Ed 

Rt 3 Box 338 

Hickory NC 28601 

6bc 3c 4abc*de* 6d 7hmtu 



Wake Teens 5 Tots Clinic 
Patricia Jackson FNP 
300 New Bern Ave 
Raleigh NC 27610 
2c 3a 4abcdef 6c 7abhjuv 



WIC Prog— Scotland Cty 

Valerie Hines 

PO Box 69 

Laurinburg NC 28352 

2d 3ab 4abde 6d 7nhm 



Watauga Cty Hlth Dept OB Prog 

Mary Reiclee RN 

Rt 5 Box 199 

Boone NC 28607 

2d 3c 4abc*e* 6d 7chjmt 



Preterm Birth Prevention 
Wake Area Hlth Ed Ctr 
Susan Runsey 
300 New Bern Ave 
Raleigh NC 2761 
2c 3c 4abc 6ab 7it 



EFNEP 

Food Nutrition Dept 

Sarah M Hinton RD 

US Dept Agric 

Box 7605 

Raleigh NC 27695-7605 

2bc 3b 4ab 6d 7dho 



Maternal/Child Hlth Migrant Proj 

Tri-Cty Comm Hlth Ctr 

Kim Larson RN 

Unic NC Sch Pub Hlth 

PO Box 237 

Newton Grove NC 28366-0237 

2ab 3ab 4abc*f* 6d 71hmuv 



Child Nutrition & Nutrition Ed 
Francis C Parker RD 
Kinston Cy Schs 
1202 Harding Ave 
Kinston NC 28501 



New River Mental Hlth Ctr—Fetal 

Alcoholism Syndrome Prog 

Judy G South 

Mental Hlth Ed 

Route 5 Box 20-A 

Boone NC 28607 

2c 3c 4b 6ab 7m 



136 



RESOURCES 



Caldwel 1 Cty Hlth Dept 
Mary Jugg Styres Don 
PO Box 868 

Lenoir NC 28645 
2b 3c 4ab 6d 7chimu 

Burke Cty Well-Child Prog & 

Maternity CI inic WIC 

Betty Garrou RN 

PO Box 1266 

Morgantown NC 28655 

2d 3c 4abce 6d 7nhmu 

Iredell Cty Hlth Dept 
Prenatal Clinic 
Becky Anderson RN PHN 
PO Box 1268 

Statesville NC 28677 
2c 3ab 7ab 6b 7chu 

Alexander Cty Hlth Dept 
Prenatal Clinic 
El izabeth King 
322 1st Ave SW 
Taylorsville NC 28681 
2bc 3c 4ab 6bc 7chkmu 



KEY 



Henderson Cty Hlth Dept 
Barbara Stanley RN 
1347 Spartanburg Hwy 
Hendersonville NC 28739 
2c 3c 4abc*e 6d 7chmu 



Graham Cty Hlth Dept 
Karen Wi 1 1 iams 
PO Box 546 

Robbinsville NC 28771 
2c 3c 4bd 6d 7chmu 



Jackson Cty Hlth Dept 
Sylvia Smith 
102 Scotts Creek Rd 
Sylvia NC 28779 
2c 3c 4b 6b 7chm 



Parents Helping Parents 
/Preparation for Parenthood 
Jean Blackburn 
Coord Nursing/Hlth Svcs 
American Red Cross/Ashevi 1 le 
100 Edgewood Rd 
Asheville NC 28804 
2d 3c 4ab 6d 7bhmu 



Belcourt Indian Hosp 
Colleen L Longer MSW 
Dir MH/SS 
US Pub Hlth Svc 
Belcourt ND 58316 
2c 3c 4d 6d 7ghmu 



Comm Hlth Nursi ng--Prenatal 
Postpartum/Wel 1 Child Clinic 
Lesl ie Carlson DCHN 
Pub Hlth Svc Indian Hosp 
Belcourt ND 58316 
2d 3c 4bh 6d 7ghmuv 



EPSDT/ND Dept Human Svcs 

Doris M Schel 1 

Admin 

3rd Fl Judicial Wing St Capitol 

Bismarck ND 58502 

2d 3a 4abcdef 6d 7ehmu 



Newborn Prog Dental Div 

ND Hlth Dept 

State Capitol 

Bismarck ND 58505 

2bc 3c 4bd 6c 7q 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c • 7th-9th and 10th grade and above 

2d - all levels 



3a 


Teenager 








3b 


Young adult 


and older 


adult 


3c 


Both 








Ethnic group(s) 








4a 


Black 








4b 


■ White 








4c 


Hispanic 








4d 


Native American 






4e 


Asian/Pacific 


Islander 






4f- 


Other 









Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC Prog--Richland Cty 

Ruby Sinner 

413 3rd Ave 

Wahpeton ND 58075 

2c 3ab 4bcd 6bc 7nh 



Optimal Pregnancy Outcome Proj 

ND Dept Human Svcs 

Mary Schaefer 

Comm Hlth Ctr 

401 3rd Ave N 

Fargo ND 58102 

2d 3ab 4abde &b 7ihuv 



EFNEP--ND St Univ Coop Ext Svc 

Sue Fowler 

US Dept Agric 

PO Box 5016 

Fargo ND 58105 

2d 3b 4abcd 6d 7dh 



WIC Prog--Custer Dist Hlth Unit 

Loa Jean Mi 1 ler 

WIC Coord 

301 1st St NE #201 

Mandan ND 58554 

3c 4bde 6bc 7nhm 



Minni-Tohe Hlth Ctr 

US Pub Hlth Svc 

PO Box 400 

New Town ND 58763 

2c 3ab 4d 6bc 7ghm 



WIC Prog--Univ NE Med Ctr 

Margot Mason RD 

Dir 

412 Ctr Mall 42nd and Center 

Omaha NE 68105 

2d 3c 4abc*de*f 6bc 7nhm 



You & Your Baby Prenatal 

Classes 

Doris Westman 

Visiting Nurse Assn Omaha 

4409 S 42 Ave 

Omaha NE 68107 

2bc 3ab 4ab 6bc 7ahu 



137 



RESOURCES 



Head Start Chi Id Devel 

Ardel la Caldwel 1 

HI th Coord 

3025 Parker St 

Omaha NE 681 1 1 

2c 3b 4abc*de 6d 7khu 



NE Dept HI th Nutrition Div 

Kathleen Taylor MS RD 

PO Box 95007 

Lincoln NE 68509-5007 

2bc 3c 4abc*de* 6bc 7hm 



Child Hlth Assurance Prog 

Janice Coffery 

NH Dept Hlth/Welfare 

Hazen Dr 

Concord NH 03301 

3c 4abc*de* 6d 7kh 



Salvation Army Booth 

Clinic & Residence 

Mary Sibley RN 

426 S 40th St 

Omaha NE 68131 

2c 3c 4abcd 6b 7bhmu 



Lincoln-Lancaster Cty 

Hlth Dept 

M Jane Ford 

2200 St Mary's 

Lincoln NE 68502 

2d 3c 4abc*de 6d 7chmqu 



Lincoln Counc Alcoholism/Drugs 

Fetal Alcohol Syndrome Prev 

Becky Beardsely RN/BSN 

FAS Prog Coord 

215 Centennial Mall S Ste 212 

Lincoln NE 68508 

2c 3c 4abcd 6ab 7m 



Survival Skills 

Rae Hope Putney 

YWCA 

1432 N St 

Lincoln NE 68508. 

2bc 3ab 4abcd 6d 7ahmu 



Nebraska Migrant Hlth Proj 

Frankl in Harris 

State Dept of Hlth 

Box 95007 

Lincoln NE 68509 

2d 3c 4abc*de 6d 71hmu 



EPSDT/NE Dept Social Svcs 

Sandi Kahlandt 

PO Box 95026 

Lincoln NE 68509 

2d 3c 4abcdef 6c 7e 



Nebraska Aid to Dependent 

Children-Unborn Prog 

George Kahlandt 

PO Box 95026 

Lincoln NE 68509 

2c 3c kf 6b 7i 



WIC Prog— Open Door Hlth Ctr 

Ann Weidenbenner RD 

140 S 27th St 

Lincoln NE 68510 

2d 3c 4abcde* 6bc 7nh 



Ctl NE Counc on Alcoholism 

Dori s Weaver 

Shei la Anderson 

706 W 1st 

Grand Island NE 68801 

2d 3c 4abcdef 6ab 7m 



La Leche League of NE 

Carole Wrede 

Area Coord 

Rt 1 Box 91 

Greeley NE 68842 

2c 4ac 4abcde 6d 7obhme 



Birthright Pregnancy Care Ctr 

Claire S Hupf RN 

Dir 

421 N Lincoln Ave 

Hastings NE 68901 

2d 3c 4abc* 6d 7bhmupv 



NAPS — Newborn and 
Parent Support 
Charlene Turner RN MS 
421 N Lincoln 
Hastings NE 68901 
2d 3c 4abc*de 6c 7k 



Early Teen Pregnancy Prog 
Mary Harrington 
Social Worker 
Child/Family Svcs of NH 
99 Hanover St 
Manchester NH 03105 
2c 4b 6d 7abhimuv 



Prenatal CI inic Bur 

Maternal/Child Hlth 

Ruth Abad 

MPH 

NH Div of Pub Hlth 

Hazen Dr 

Concord NH 03301 

2bc 3ab 4b 6b 7bhm 



Parent-Chi Id Ctrs 

Donna Raycraft 

CH NH Comm Mental Hlth Svcs 

PO Box 2032 

Concord NH 03301 

2c 3c 4bc 6bc 7kh 



Early Intervention Network 

State of NH 

Susan Curtis 

Exec D i r 

18 Low Ave 

Concord NH 03301 

2d 3c 4abcde 6c 7khr 



Breastfeeding Counselor 

Roxanne Kreyl i ng/Karen Pierson 

WIC Program 

PO Box 603 

Keene NH 03448 

2c 3ab 4ad 6abc 7o 



WIC Prog--Ammonoosuc Family 

Hlth Svcs 

Jul ie Dustin RD 

20 Main St 

Littleton NH 03561 

2c 3ab 4abcd 6d 7nhio 



Injury Prev Resource and 

Research Ctr 

Deborah M Prum 

MALS Proj Dir 

Dartmouth Med Sc Butler II 

Hanover NH 03756 

2d 3c 6d 7k 



Lebanon Area Hlth Care 
Young Mothers Group 
Jill Glassmitl 
Commerce Bldg 
Lebanon NH 03766 
2c 3ab 4b 6c 7hkmpu 



Newmarket Regional Hlth Ctr 

Margery Clark 

14 Elm St 

Newmarket NH 03857 

2bc 3ab 4be 6d 7bhmu 



138 



RESOURCES 



Children 6 Youth Proj of 

Mt Washington Valley 

Carrol 1 Bergin RN 

Box 904 

N Conway NH 03860 

2d 3c 4abe 6c 7khmpu 



Teenage Expectant Mothers 

(T.E.M. Clinic) 

Carmel Amodeo RN 

March of Dimes 

30 Baldwin Ave 

Jersey City NJ 

2b 3a 4ac* 6bc 7ahkhmu 



WIC Prog--Hoboken 

Judith Bai ley RD 

916 Garden St 

Hoboken NJ 07030 

2c 3c 4abc*e 6bc 7nh 



KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language) s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d- All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7i - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 
7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Improved Pregnancy Outcome 

Passaic Gen Hosp 

01 ive C Samuels RN 

IPO Proj Oir 

350 Blvd 

Passaic NJ 07055 

2c 3c 4abc*de* 6bc 7ih 



WIC Prog — Passaic 

Div Hlth Dept Human Res 

Elaine Nadel 

WIC Coord/Nutritionist 

Cty Hall 330 Passaic St 

Passaic NJ 07055 

2d 3c 4abc*e 6d 7nhm 



La Leche League of Newark 

Mi la Jasey 

9 Keasbey Rd 

S Orange NJ 07079 

2c 3c 4a 6bc 7okhim 



UMDNJ/SHRP Nurse-Midwifery 

Educ Prog 

Elaine Diegmanncny 

100 Bergen St 

Newark " NJ 07103 

2d 3ab 4abc*f* 6bc 7fhmu 



Parent Chi Id Ctr 

Edna Jones 

201 Bergen St 

Newark NJ 07103 

2c 3b 4ac*f 6bc 7kv 



St James Hosp Maternity Clinic 

Gisela Rodriguez ACSW 

155 Jefferson St 

Newark NJ 07105 

3c 4abc*def 6b 7ihkmv 



El izabeth Gen Med Ctr 

Out Patient CI inic 

Laurie Westra RN 

Assoc Admi Dir Amer Care Svc 

925 E Jersey St 

Elizabeth NJ 07201 

2b 3c 4abc*ef 6d 7b 



International Inst of NJ 

Nancy Long 

880 Bergen Ave 

Jersey City NJ 07306 

2d 3b 4cef 6d 7bhu 



La Leche League of Paterson 

Judy Kaplan 

344 E 36th St 

Paterson NJ 07504 

2bc 3c 4abcde 6bc 7okhm 



Bergen Cty Dept of Hlth Svcs 

Pub Hlth Nursing Div 

327 Ridgewood Ave 

Paramus NJ 07652-4895 

2c 3c 4bce*f 6c 7chmu 



Monmouth Cty Chap 
American Red Cross 
Lois Wood RN Dond HS 
830 Broad St 

Shrewsbury NJ 07701 
2cd 3a 4abc 6d 7ahmu 



Teenage Alternate Pregnancy 

Prog (TAPP) 

Linda Knust 

Coord 

Monmouth Cty Educ Svcs Comm 

17 Broad St 

Eatontown NJ 07724 

2c 3a 4abc 6bc 7abhjkmuv 



Parent Ctr 

Mary F Bryant 

Monmouth Med Ctr 

1501 Maryland 2R, AB 72202 

Long Branch NJ 07740 

2d 3a 4a 6bc 7a 



Monmouth Med Ctr Pollack Clinic 

J L Harper MD 

200 Pavilion Ave 

Long Branch NJ 07740 

3c 4abce 6d 7bhmu 



Monmouth Med Ctr Prenatal 

Clinic Classes 

Noel Murgio RN ACCE 

3rd Ave 

Long Branch NJ 07740 

2d 3c 4abce 6bc 7i 



Infant/Chi Id Care 

and Parenting Courses 

Norma Weisman RN BSN 

American Red Cross/Camden Cty 

312 Cooper St 

Camden NJ 08101 

2c 3b 4ab 6bc 7kh 



139 



RESOURCES 



Camden Cty Adolescent 

Fami 1 y Life Prog 

Ruth W Salmon PhD 

Coord 

2101 Ferry Ave., 1800 Pavilion 

Camden NJ 08104 

2a 3ab 4abc 6d 7abhmu 



WIC Prog--Camden Cty Div Hlth 

Barbara M Kel ler 

WIC Coord/Pub Hlth Nutri 

2101 Ferry Ave 

Camden NJ 08104 

2c 3c 4abc*e* 6bc 7nhm 



WIC Prog--Atlantic Cty 
Col leen Burke 
201 S Shore Rd 
Northfield NJ 08225 
2b 3c 4abc*de 6bc 7nhmq 



WIC Prog--Atl antic Cy 

Luis A German 

Prog Coord 

2304 Pacific Ave 

Atlantic Cy NJ 08401 

2c 3c 4abc*de 6d 7nh 



Fami ly Life Prog 

Peggy Jackson 

Urban League Metro Trenton 

209 Academy St 

Trenton NJ 08608 

2bc 3ab 4b 6bc 7ahm 



WIC Prog--Trenton 

Janice Padula MS RD 

Pub Hlth Nutritionist 

Cty Hall Annex 319 E State St 

Trenton NJ 08608 

2d 3c 4abc*de 6d 7nh 



Henry J Austin Hlth Ctr 
NJ Dept Hlth/Human Svcs 
Victoria B Burrel 1 
321 N Warren St 
Trenton NJ 08618 
2d 3c 4abc 6ab 7ihkmu 



Div Med Assistance Hlth Svcs 

Thomas M Russo 

Dir 

NJ Dept Human Svcs 

CN 712 7 Quakerbridge Plaza 

Trenton NJ 08625 

2d 3c 4abc*de*f* 6d 7e 



NJ Dept of Hlth-Dental Hlth Prog Albuquerque Area Indian Hlth Svc 



E Will son Baker DDS/MS 
CN 364 

Trenton NJ 08625 
2c 3b 4abc*de 6b 7q 



WIC Prog--NJ St Dept Hlth 
Debra M Harlan MS RD 
CN 364 

Trenton NJ 08625 
2d 3c 4abc*def* 6d 7nh 



Prepared Childbirth Prog 
HJ Austin Hlth Ctr 
Jo-Ann Ennis BS RN 
Coord Childbirth Ed 
750 Brunswick Ave 
Trenton NJ 08638 
2d 3ab 4ac* 6bc 7ihmu 



Adolescent Pregnancy Proj 

Mary Dodson RN 

Coord 

Hunterdon Med Ctr 

Flemington NJ 08822 

2cd 3ab 4ab 6d 7ahikmu 



WIC Prog--Middlesex Cty 
Pub Hlth 

Lynda C Covil le RD 
Coord Nutritionist 
390 George St 8th F1 
New Brunswick NJ 08901 
2c 3c 4abc*def 6bc 7nh 



Comp Adolescent 

Pregnancy Svcs (CAPS) 

Karen Glass MSW 

St Peters Med Ctr 

254 Easton AVe 

New Brunswick NJ 08903 

2cd 4abcd 6d 7ahkmtu 



WIC Prog--Sandoval Indian Pueblo 

Rama Ray 

PO Box 580 

Bernalillo NM 87004 

2c 3c 4d* 6bc 7nhm 



Cuba Hlth Ctr 

Jean Rounds PA-C 

Box 638 

Cuba NM 87013 

2d 3c 4abc*d* 6d 71ahu 



Judith Kitles MD MPH 
US Pub Hlth Svc 
500 Gold SW 

Albuquerque NM 871 01 
2c 3c 4d 6d 7ghmu 



Indian Childrens Prog 
Mary M Mokler 
US Pub Hlth Svc 
2401 12th St NW 
Albuquerque NM 87102 
2d 3ab 4d* 6ac 7g 



Hlth Promotion Prog 

Albuquerque Family Hlth Ctr 

Jackie Peterson 

Coord 

2001 N Centro Familiar Blvd SW 

Albuquerque NM 87105 

2d 3c 4abc*d 6c 7kp 



PHS Indian Hosp 
Patricia S Mead RD 
US Pub Hlth Svc 
801 Vassar Dr NE 
Albuquerque NM 87106 
2d 3c 4abcd 6d 7gh 



Maternal Child Hlth 
Navajo Sch Board 
Louise Martine MCH 
Pinehill Hlth Ctr 
Drawer K 

Pinehill NM 87321 
2c 3c 4d* 6d 7ghm 

Santa Fe Svc Unit 

Indian Hlth Svc 

Carol Johnson 

Pub Hlth Nutritionist 

US Pub Hlth Svc 

1700 Cerrillos Rd 

Santa Fe NM 87501 

2b 3c 4d 6d 7hm 



NM St Dept Ed 

Wi 1 1 iam Owen Blair MD 

Ed Bldg 

Santa Fe NM 87501-2786 

2bc 3a 4abcde 6a 7j'hmu 

Chi ldrens Med Svcs 

Marilyn Sakara ACSW 

Senior Superv 

PO Box 968 

Santa Fe NM 87504 

3c 4abc*de 6bc 7khr 



140 



RESOURCES 



EPSDT/NM Human Svcs 

Med Assistance Prog 

Carmen Rodriguez RN 

Prog Mgr 

PO Box 2348 

Santa Fe NM 8750^-23^8 

3ab 6abc*de 7e 

La Leche League of NM 

Juanita Watt ACC 

424 Ridgecrest 

Los Alamos NM 87544 

2d 3c 4abcde 6bc 7ok 

Truchas Clinic 

Jessica Doyle PA 

Box 7 

Truchas NM 87578 

2ac 3b 4c* 6bc 71 h 

Prepared Chi 1 dbi rth 

E NM Med Ctr 

Karen Hutchinson 

405 W Country Club Rd 

Roswell NM 88201 

2c 3c Abe 6b 7i 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Hobbs Lovington HI th Dept 

Prenatal Prog 

Barbara Slago CNP 

NM Hlth Environ Dept 

PO Box 2468 

Hobbs NM 88240 

2a 3c 4abc* 6d 7chiju 



Green Cty Alcohol Info 

& Referral Ctr 

Art O'Connel 1 CCTE 

80 Woodland Ave 

Cat Skill NV 12414 

2c 3c 4ab 6d 7m 



WIC Prog--Humboldt Cty 
Mary Agnes Boni 
501 Bridge St Rm 2 
Winnemucca NV 89445 
2c 3c 4abc*d 6d 7nhm 



Yerington Tribal Hlth Clinic 
Kathy Fawcett CHN 
171 Campbell Ln 
Yerington NV 89447 
2c 3ab 4d 6bc 7ghmu 



EPSDT/NV Dept Human Resources 

Gloria Deyhle RN 

NV Medicaid 

251 Jeanell Dr 

Carson City NV 89710 

2d 3c 4abc*def 6ab 7eh 



OB/GYN Prenatal Care 

USAF Hosp Torrejon 

Kerrie Lindberg 

Charge Nurse OB/GYN 

Box 3249 

Apo NY 09283-5370 

2c 3b 4abc*de 6d 7ihmu 



National Board 

YWCA of the U S A 

Janet L Sola MD 

Prog Cons 

726 Broadway 

New York NY 10003 

2c 3a 4abcde 6ab 7ajhu 



Resources for Children with 
Special Needs 
Karen T Schlesinger 
200 Park Ave S Ste 816 
New York NY 10003 
2d 3c 4abc*def* 6c 7krv 



Patient Ed Prog--Materni ty 

Infant Care Family Ping Prog 

Donna OHare MD 

Proj Dir 

MHRA of NYC, Inc. 

225 Broadway 

New York NY 10007 

2d 3c 4a*f* 6d 7ihmou 

Pregnancy Hlth Line 

New York Cy Dept Hlth 

Vicki Breitbart 

Dir- 

280 Broadway Rm 303 

New York NY 10007 

2c 3c 4abc 6ac 7c 

Maternity Infant Care 

Family Planning Projects 

Donna OHare MD 

Proj Dir 

225 Broadway 

New York NY 10007 

2d 3c 4c*f* 6d 7bhmou 



Teen Reach Prog--Maternal 

Infant Care Family Ping Prog 

Donna OHare 

Proj Dir 

Med/Hlth Research Assn of NY Cy 

225 Broadway 

New York NY 10007 

2d 3a 4ac*f* 6a 7a ij 

Teen Linkage Prog--Maternal 

Infant Care Family Ping Prog 

Donna OHare 

Proj Dir 

Med/Hlth Research Assn of NY Cy 

225 Broadway 

New York NY 10007 

2d 3c 4ac*f* 6d 7ahiv 

Askable Parents Prog--Materna1 

Infant Care Family Ping Proj 

Donna OHare 

Proj Dir 

Med/Hlth Research Assn of NY Cy 

225 Broadway 

New York NY 10007 

2d 3c 4ac*f* 6d 7ahmou 



Patient Ed Prog--Materni ty 

Infant Care Family Ping Prog 

Donna OHare 

Proj Dir 

Med/Hlth Research Assn of NY Cy 

225 Broadway 

New York NY 10007 

2d 3c 4ac*f 6d 7bhijmu 



141 



RESOURCES 



Preterm Birth Prevention Prog 

Maternity/Infant Care Family Pin 

Donna OHare MD 

Proj Dir 

MHRA of NYC Inc 

225 Broadway 

New York NY 10007 

2D 3AC 4c*f* 6d 7bhmou 



Maternity Infant Care 

Family Planning Proj 

Donna O'Hare MD 

Proj Dir 

MHRA of NYC Inc 

225 Broadway 

New York NY 10007 

2d 3c 4a*F* 6d 7bhmou 



Comm Family Planning Counc 

Suzanne Hanchett 

184 5th Ave 

New York NY 10010 

3c 4abc*de*f* 6ab 7ihu 



Tools for Teen Programs 
Edith A MacLach La V 
120 W 14th St 
New York NY 10011 
2bc 3ab 4abc* 6d 7ahpu 



Chinatown Hlth Clinic 

Sue Lee Rn 

89 Baxter St 

New York NY 10013 

2d 3c 4abcde* 6d 7bhu 

Mayoral Initiative to Reduce 

Infant Mortal ity 

Barbara Crook 

Bur Pub Hlth Educ 

125 Worth St 

New York NY 10013 

2d 3c 4abc*def* 6d 7iahkmu 

Prev Svcs for Deaf Youth & 

Families/NY Foundling Hosp 

Vicki Baum 

Dir 

1175 3rd Ave 

New York NY 10014 

2b 3c 4ac*ef* 6d 7kv 

St Lukes--Roosevel t Hosp 

Lynn Perton RD 

Chief Nutritionist/Pediatrics 

430 W 59th St 

New York NY 10019 

2c 3ab 4abc* 6d 7o 



National Urban League Affiliate 

Devel of Adol Preg/Parent Prog 

Deborah Taylor 

500 E 62nd St 

New York NY 10021 

3a 4a 6d 7a 



Richard Smith Dept Parent Ed 

NY Found 1 ing Hosp 

Judith Elkin CSW 

1175 3rd Ave 

New York NY 10021 

2d 3ab 4abc* 6c 7k 



Child Abuse Rehab Prog 
NY Found 1 ing Hosp 
Vincent J Fontana 
1175 3rd Ave 

New York NY 10021 
2d 3c 4abc*e 6bc 7kp 



Operation Baby Track 

American Red Cross 

Diane L Austin 

150 Amsterdam Ave 

New York NY 10023 

3c 4abc*def* 6bc 7k 



Comm Sch for Pregnant 

Girls - (PS 911) 

I sabel le Gross 

Louise Wise Svcs 

12 E 94 St 

New York NY 10128 

2d 3a 4abc*de 4amh 



Louise Wise Svcs Residence 

for Mothers and Babies 

S. Rogers 

Exec D i r 

Louise Wi se Svcs 

12 E 94 St 

New York NY 10128 

2cd 3ab 4abc*de 6u 7ahkmu 



Staten Island Hosp 

Pre-Natal Clinic 

Ann Boresky 

Nurse Mgr 

475 Seaview Ave 

S I NY 10305 

2c 3ab 4abc 6bc 7ihmu 



The Hub--A Ctr for Change 

Yolanda E Smith 

349 E 149th St 

Bronx NY 10451 

2c 3a 4ac 5ab* 6d 7abhmuv 



Segundo Ruiz Bel vis Neighborhood 

Fami ly Care Ctr 

David Stevens MD 

NYCHHC 

545 E 142nd St 

Bronx NY 10454 

2d 3c 4abc*e 6d 7bhmtu 



S Bronx Mental Hlth Counc 

Constance Karros 

Assoc Exec Dir 

781 East 142nd St 

Bronx NY 10454 

2bc 3c 4abc* 6d 7ihmuv 



NY Found 1 ing Hosp 

-Fami ly Day Care 

Sr Shei la Fi nucane 

Admin Superv 

391 E 149th St Rm 319 

Bronx NY 10455 

2c 3c 4abc* 6d 7kh 



Dr Martin Luther King Jr 

Hlth Ctr 

3674 3rd Ave 

Bronx NY 10456 

2d 3c 4ac* 6d 7bhmu 



Montefiore Family Hlth Ctr Low 

Birthweight Prevention Proj 

Juan Rivas MD 

Proj Dir 

360 E 193rd St 

Bronx NY 10458 

3c 4abc*e 6b 7ihmtu 



SPRANS-Breastfeeding Proj 
Albert Einstein Coll Med 
1300 Morris Park Ave Rm 11N13 
Bronx NY 10461 
2d 3c 4abc* 6d 7ok 



WIC Prog 

Kathleen Carpenter 

WIC Coord 

Comp Family Care Ctr 

1175 Morris Park Ave 

Bronx NY 10461 

2c 3c 4abce* 6d 7nhm 



Dept Hlth 

S Bronx Dist 

El izabeth Wynn 

Superv PHN 

1309 Fulton Ave 

Bronx NY 10466 

2c 3c 4abc*f* 6c 7khu 



142 



RESOURCES 



Mount Vernon Neighborhood 

Hlth Ctr 

Annette Rose 

Westchester Cty 

107 W 4th St 

Mount Vernon NY 10550 

2ac 3c 4abc* 6d 7bhmtu 



WIC Prog 

New Rochelle Hosp Med Ctr 

Dorothy Rosner 

Nutri tioni st 

16 Guion PI 

New Rochelle NY 10801 

2d 3c 4abc*ef* 6bc 7nh 



Sunset Family Hlth Ctr 
Monica Burns 
Lutheran Med Ctr 
150 55th St Rm 2063B 
Brooklyn NY 11220 
2d 3c 4abc*def 6d 7bhmtu 



Greenburg Neighborhood 

Hlth Ctr 

Carolyn B George 

330 Tarrytown Rd 

White Plains NY 10607 

2d 3c 4abc*e 6d 7chmu 



Kaiser Found Hlth Plan of 

the Northeast 

Beth Wil Is 

145 Westchester Ave 

White Plains NY 10703 

2c 3c 4abcdef 6d 7bhm 



The codes following each respondent organization name 
and address correspond with these program 
characteristics" 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 



7i - Prepregnancy 
7k- - 



Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC Prog—Orange Cty Hlth Dept 
Nancy Neyerl in RD 
10 Courtland St 
Middletown NY 10940 
2d 3c 4abc*de 6d 7nhikm 



Proj Turning Point 

Margarita Rivera 

135 Convent Rd 

Nanuel NY 10954 

2bc 3a 4abc*de 6ab 7av 



St Anthony Comm Hosp 

Diane L DeFreest RN HN 

OB/GYN 

15 Maple Ave 

Warwick NY 10990 

2c 3ab 4b 6d 7h 



Special Obstetrical Teenage 

Clinic 

Margaret Charvis CNM 

Kings Cty Hosp Ctr 

451 Clarkson Ave Rm C7226 

Brooklyn NY 11203 

2bc 3a 6d 7ahjku 



Adolescent OB-Gyn Clinic 

Sol Neuhoff MD 

Brookdale Hosp Med Ctr 

Linden Blvd At Brookdale Plaza 

Brooklyn NY 11212 

2d 3a 4abc*def 6abc 7ahu 



Brownsville Mult Svc Family 

Hlth Ctr 

Joseph Francois 

Exec Dir 

444 Hopkinson Ave 

Brooklyn NY 11212 

2c 3b 4ac* 6d 7bhu 



Teen Proj 

Dorothy Kel ly 

Social Worker 

South Brooklyn Clinic 

Box 503 Times Plaza Stn 

Brooklyn NY 11217 

2c 3ab 4ac* 6a 7ahju 



Coney Island Comm Hlth Ctr 

Mary Jo Kennedy MD 

Med Dir 

2201 Neptune Ave 

Brooklyn NY 11224 

2c 3c 4abc 6d 7bhm 



Child Care 

Beatrice Baumann 

PS 721 Queens OTC 

41-15 104 St 

Corona NY 11368 

2b 3ab 4abce 6d 7bhjmpu 



Teen Pregnancy 6 Prevention 

Prog 

Madel ine Welch 

Coord 

Jamaica Hosp 

89 Ave & Van Wyck Expy 

Jamaica NY 11418 

2a 3ab 4abc* 6d 7ahmu 



Adolescent Pregnancy Prevention 

Prog 

Regina Little 

82-68 164th St 

Jamaica NY 11432 

2bcd 3a 4abce 6d 7ahuv 



Maternal Infant Care/Family Prog 
Margaret Naylor CNM MPH ACCE 
Jamaica Mic Clinic 
90-37 Parsons Blvd 
Jamaica NY 11432 
2d 3c 4abc*ef* 6d 7fhmu 



Child Abuse Prevention Svcs CAPS 

Alane Fagin 

Exec Dir 

Jr League Nat Counc Jewish Women 

PO Box 176 

Roslyn NY 11576 

2c 3ab 4abc 6d 7kp 



143 



RESOURCES 



PRYME Comm Hlth Ctr 

Family Planning Prog 

G. Dyson RN 

Family Planning Coord 

Rockaway Hlth Ctr 

67 10 Rockaway Beach Blvd 

Arverne NY 11692 

2c 4ac 6abc*df* 6ab 7jhu 



Carol Molfetta RD & Assoc 
Consulting Nutritionist 
52 Clay Pitts Rd 
Greenlawn NY 11740 
3b 4abc 7h 



March of Dimes/Long Island Chap 

Joan Hoyt Kornblum 

March of Dimes Birth Dfct Found 

424 Crossways Park Dr 

Woodbury NY 11797 

2bc 3c 4abc*def 6d 7ihkmr 



Child Restraint Loaner Proj for 

Low- I ncome Fam i 1 i es 

Lesl ie Fisher MPH 

NY DMV Child Hlth Bur 

Empire State Plaza 

Albany NY 12237 

2b 3c 4abc*de* 6d 7k 



Planned Parenthood of 

Dutchess-Ul ster 

Pat 111 lmann 

Family Planning & Comm Educ 

101 Hurley Ave Ste #3 

Kingston NY 12401 

2d 3c 4abc* 6d 7jhmu 



Whi le Waiting 

Hudson Valley Assoc Obstetrics 

91 Montgomery St 

Rhinebeck NY 12572 

2c 3c 4abc*f* 6bc 7ih 



CI inton Cty Dept of Hlth 
John V Andrus 
Dir of Pub Hlth 
30 Durkee St 

Plattsburgh NY 12901 
2d 3c 4ab 6d 7chmuv 



Hlth Svcs Assn Chestnut 
Ridge Hlth Svcs Ctr 
Mary Wi lkinson RN 
Childbirth Ed Coord 
8280 Willett Pkwy 
Baldwinsvil le NY 13027 
2c 3c 4abc 6bc 7ihm 



Cortland Cty Rural Hlth Svcs 

Debra A Farenga RN 

Hlth Ed 

Box B Rt 13 

Deruyter NY 13052-0502 

2c 3ab 4b 6d 71hkmu 



Hlth Promotion & Education 

K Cohen 

Capital Area Comm Hlth Plan 

1201 Troy Schenectady 

Latham NY 12110-1176 

2d 3c 4abe 6d 7b 

Teenage Mothers Prog 

Kimberly M Davis 

Sch 20 

570 N Pearl St 

Albany NY 12204 

2abc 3a 4a 6bc 7ahuv 

Whi tney M Young Jr 

Hlth Ctr 

Sharon Bisner RN FNP 

Clinical Coord 

Lark & Arbor Dr 

Albany NY 12207 

2c 3c 4abcdef 6d 7bhikmu 



E Dutchess Maternity Clinic 

Prenatal Care/Nutrition Prog 

John Scott MD 

Comm of Hlth 

Dutchess Cty Hlth Dept 

22 Market St 

Roughkeepsie NY 12601 

2d 3c 4abcde 6b 7ih 



Planned Parenthood 
202 Broadway 

Monticello NY 12701 
2d 3c 4abc* 6ac 7jhmu 



Mercy Comm Hosp 

Sr Marie James RN 

160 E Main St 

Port Jervis NY 12771 

2c 3b 4b 6bc 7bh 



March of Dimes 

Angela R Vigl iotti 

Exec Dir 

702 W Bel den Ave 

Syracusse NY 13204 

2d 3c 4abc*def 6ab 7ihmu 



Prenatal Care 6 Nutrition Prog 

Prevention of Low Birth Weight 

Richard H Aubry MD 

Onondaga Cty Hlth Dept 

750 E Adams St 

Syracuse NY 13210 

2d 3c 4abc*d 6ab 7ihmtuv 



Motherdance 

Barbara Holstein 

227 Scottholm Terrace 

Syracuse NY 13224 



WIC Prog--Albany Med Coll 

Sharon L Stein 

Coord 

CD PC Unit B New Scotland Ave 

Albany NY 12208 

2d 3c 4abc*e 6bc 7nhmo 

Primary & Preventive Care 
for Chi ldren 0-5 
Charles W White 
NY Dept Hlth/Bur Child 
Corhing Tower Rm 859 
Albany NY 12237 
3a 4abc 6c 7k 



Hudson Headwaters Hlth Network 

Shirley Anderson 

Box 137 

N Creek NY 12853 

2c 3ab 4b 6ab 71 h 



Adolescent Pregnancy 

Prevention and Services 

Becky Linnahan 

Dir 

66 Brenkerhoff St 

Plattsburgh NY 12901 

2ab 3ab 4ab 6d 7ahjuv 



WIC Prog--Herkimer 
Barbara Nowacki RN 
Clinic Dir 
270 N Main St 
Herkimer NY 13350 
2c 3c 4ab 6bc 7nhm 



North Country Childrens Clinic 

Rita Markham 

Outer Stowe St 

Lowville NY 13367 

2d 3c 4b 6bc 7hm 



144 



RESOURCES 



WIC Prog--Madison Cty 

Shi r ley Felt 

191 S Main St 

Oneida NY 13421 

2c 3b 4b 6d 7nh 

Cooperative Extension of 

Oneida Cty 

Linda Bohac 

US Dept Agriculture 

RD #1 Second St Box 126 

Oriskany NY 1 3^24 

2bc 3c 4abc* 6d 7dh 

Planned Parenthood/Mohawk Valley 

Kathleen VanVecaten NP 

CI inic Oi r 

607 N Washington St 

Rome NY MkW 

2c 3ab 4abe 6ac 7jhu 

WIC Prog— PPAMV 

Herkimer & Madison Cty 

Melanie Cook 

142*4 Genesea SE 

Utica NY 13502 

2bc 3ab 4b 6bc 7nhm 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage) si 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e • EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 



7j - Pre-pregnancy 

7k -r 



■ Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 
7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



North Jefferson HI th Sys 
Mary Lewis Bowman 
21 Fuller St 

Alexandria Bay NY 13607 
2bc 3c 4b 6bc 7ihm 



WIC Prog--St Regis Mohawk Hlth 

Svcs 

Wendy Wolfe 

Coord 

Comm Bldg 

Hogansburg NY 13655 

2bc 3c 4d 6bc 7nhm 



WIC Prog--Del aware 

Opportuni ties 

Christine Jones 

WIC Coord/Nutritionist 

119 Main St 

Delhi NY 13753 

2d 3c 4abcd 6d 7nhmt 



SEARCH/Svcs to Enable Adol to 
Rear Children in Hlth 
Charlotte Lawrence-Nichols RN 
Wi 1 son Hosp 
33-57 Harrison St 
Johnson City NY 13790 
2bc 3ab 4ab 6bcd 7ak 



Childbirth & Parenting Educ 
E Whi taker RNC 
United Hlth Svcs 
Box 5^0 Wi lson Ctr 
Johnson Cy NY 13790 
2d 3c 4abc*de 6d 7bhmtu 



PACE 

Allentown Comm Ctr (ACC) 

Sabina Zolte 

ACC & Parents Anonymous 

1 1 1 Elmwood Ave 

Buffalo NY 14201 

2c 3c 4ab 6d 7k 

Hlthy Mothers Healthy Babies 

Coalition of Erie Cty 

Ronald L Downey 

95 Frankl in St 

Buffalo NY 14202 

2d 3c 4abc*def 6d 7bhmu 

Jesse Nash Hlth Ctr 
Constance B. Sparks 
Erie Cty Dept Hlth 
608 Wi 1 1 i am St 
Buffalo NY 14206 
3a 4abc 6d 7ahu 



Maternity Infant Care Prog 

Terri Guzinski 

Erie Cty Dept Hlth 

95 Franklin St 

Buffalo NY 14206 

2d 3c 4abc*def 6bc 7chkmu 



Geneva B Scruggs Comm Hlth 

Care Ctr 

Li 1 1 ian J Davi s 

Exec D i r 

567 Kensington Ave 

Buffalo NY 14215 

2c 3c 4abc* 6d 7bhmu 



Special Delivery Kenmore 
Mem Hosp OB Dept 
Jacqueline Kelsey RN 
2950 Elmwood Ave 
Kenmore NY 14217 
2c 3c 4abcdef 6d 7ihmu 



Intensive Care Nursery Family 

Svc Prog 

Wi 1 1 iam A Zorn MD 

219 Bryant St 

Buffalo NY 14222 

2d 3c 4abcdef 6c 7kmv 



Rochester Adolescent Maternity 

Proj (RAMP) 

Mary Sprik 

Coord 

Strong Memorial Hosp 

Box 690/601 Elmwood Ave 

Rochester NY 14526 

2c 3a 4abcd 6b 7ahiu 



WIC Prog — Anthony L Jordan 

Hlth Ctr 

Rose Donnel ly RD 

WIC Nutritionist/Acting Coord 

PO Box 876 

Rochester NY 14603 

2b 3c 4abc*e 6d 7nhm 



Adolescent Prenatal Svcs Prog 

Marylane Manan 

Planned Parenthood Roch Cty 

24 Windsor St 

Rochester NY 14605 

2c 3a 4abc 6bc 7ahijmu 

Journey to Self--The Road to 

Self-Success 

Vi rginia A Fl aberty 

50 Prince St 

Rochester NY 14607 

2b 3a 4abc 6d 7ahv 



145 



RESOURCES 



Opportunities for Pregnant & 
Parenting Teens 
Dorothy A Gordon 
150 Floverton 
Rocherster NY 1 461 
2c 3ab 4abc 6d 7ahkmuv 



Adolescent Pregnancy 

Prevention Prog 

Marion Weber 

Monroe Cty HI th Dept 

111 Westfall Rd Caller 632 

Rochester NY 14692 

2b 3a 4abc 6bc 7a ik 



Chautaugua Cty Hlth Dept 

Prenatal Clinic 

Judy Rafson RN BSN CFMP 

311 Cherry St 

Jamestown NY 147 01 

2bc 3c 4abc* 6bc 7ih 

Basics of Breastfeeding 

EFNEP Breastfeeding Educ Prog NY 

Christine M Olson 

Cornell Univ Div Nutri Sci 

Cornell Univ 376 MVR Hal 1 

Ithaca NY 14853 

2b 3c 4abc*def 6bc 7dho 

EFNEP— Cornell Unic Coop Ext Svc 

Div Nutritional Sciences 

Muriel Brink 

US Dept Agric 

283B MVR Hall Cornell Univ 

Ithaca NY 14853 

2ab 3c 4abc*de 6d 7dh 

Teen Age Parent Prog (TAPP) 
James Hal icy 

Elmira Cy Sch Dist Coop Svcs 
Elmira NY 14901 
2c 3a 4abc 6d 7ahm 



Car Seat Ed/Loan Prog 

American Red Cross/Chemung Cty 

Linda Swift 

Prog Coord 

462 W Church St 

Elmira NY 14901 

2d 3c 4ab 6c 7k 



Prenatal Clinic/Planned 

Parenthood Southern Tier 

El izabeth Howel 1 

Exec D i r 

200 E Market St 

Elmira NY 14903 

3c 4ab 6ab 7ih 



Child Family Hlth Services 
Nancy Shapiro 
Delaware Cy-Cty Hlth Dept 
115 N Sandusky St 
Delaware OH 43015 
2d 3ab 4abc 



Knox Cty Hlth Dept 

Perinatal Prog 

Denise Campbel 1 

117 E High St 

Mt Vernon OH 43050 

2b 3c 4ab 6bc 7chmu 



Newark Cy Hlth Dept 
Robert B Greiner DVM 
40 W Main St 

Newark OH 43055 
2d 3c 4abc*def 6c 7chku 



Licking Cty WIC Prog and 
Prenatal Ed Prog 
Linda Scovern RD MPH 
675 Price Rd NE 
Newark OH 43055 
3c 4abce 6bc 7nhm 



Franklin Cty Children Svcs 

Patricia Matheny 

1951 Gantz Rd 

Grove City OH 43123 

2d 3c 4abc*e 6d 7bhm 



Logan-Hocking Cty Hlth Dept 

Anna C Gerkeny RD 

SR 664 

Logan OH 43138 

2d 3c 4abc*def 6bcd 7achmuv 



WIC Prog--Madi son Cty 

Barbara Ami ing 

61 E High St 

London OH 43140 

2c 3ab 4ab 6c 7nhm 



Child Family Hlth Svcs 

Judy King 

421 Main St 

Zaneville OH 43201 

2d 3c 4abe 6d 7chktu 



Mi ldred J Roush 

RD 

2889 

Columbus OH 43202 

2b 3c 4abc 6c 7h 



Preparation for Parenthood 

Dawn McClaine RN 

Assist Dir Nursing/Hlth Svc 

American Red Cross Columbus Chap 

995 E Broad St 

Columbus OH 43205 

2c 3c 4abc 6bc 7ih 



Comm Pediatric — Adolescent Svcs 
Childrens Hosp 
700 Childrens Dr 
Columbus OH 43205 
2d f3ab 4abcdef* 6c 7khp 



KISS--Kiss In Safe Seats 

OH Dept Hwy Safety 

Jill Berington 

PO Box 7167 

Columbus OH 43205 

2ab 3c 4abcdef 6c 7k 



OH St Univ Hosp OB/GYN Clinic 

Cheryl Mel ley 

Mgr OB/GYN Clinic 

Area 2C 

456 CI inic Dr 

Columbus OH 43210 

2c 3a 4ab 6ab 7ihmu 



OSU Pediatric Practice 
Uni v Hosp Clinic 
Lindsey K Grossman MD 
456 Clinic Dr Rm 2100 
Columbus OH 43210 
2d 3c 4abe 6c 7k 



146 



RESOURCES 



EFNEP--OH St Univ Coop Ext Svc 

Maternal Nutrition Calendar 

Alma M Saddam 

Ext Spec — Nutrition 

US Dept Agric 

1787 Neil Ave 

Columbus OH 43210 

2b 3c 4abce 6ab 7dhm 



Columbus Hlth Dept 

Perinatal Proj 

Elaine Swank RN 

181 S Washington Blvd 

Columbus OH 43215 

2ab 3c 4abce 6b 7chmu 



OH Dept Bur Alcohol 

Abuse/Alcoholism Recovery 

Frank Underwood 

State Prevention Coord 

PO Box 118 

Columbus OH 43215 

2c 3c 4abc 6d 7m 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f- Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 
7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparacion for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC Prog--Columbus Hlth Dept 
Paul Eckstein RD 
1 81 S Washington Blvd 
Columbus OH 43215 
2d 3c 4abc*e* 6d 7nh 



Thanks Mom and Thanks Mom for 

Not Drinking 

Alcohol During Pregnancy 

Virginia H Jones MD 

OH Dept Maternal/Child Hlth 

PO Box 118 

Columbus OH 43216 

2c 3abc 4ab 6ab 7im 



Crittenton Ctr of Family 
Couns 6 Crittenton Svcs 
Judy Sweeney 
1229 Sunbury Rd 
Columbus OH 43219 
2bc 3ab 4ab 6bc 7ah 



Two Cty/NCO Child Family 

Hlth Svcs 

Deborah L Crothers RN 

Nurse Coord 

98 McKinley Park Dr 

Marion OH 43302 

2bc 3c 4ab 6d 7chmu 



WiC Prog--Logan Cty Hlth 
L Jenkins RP 
815 S Main 

Bellefontaine OH 43311 
2c 3c 4abe 6d 7nhmu 



WIC Prog--Wyandotte Cty Hlth 

Dept 

Cindy Kraus RN 

127-A S Sandusky Ave 

Upper Sandusky OH 43351 

2c 3c 4bc 6d 7nho 



Sandusky Cty Hlth Dept 
Jean M Gayes 
1909 Rahert Ave 
Fremont OH 43420 
2d 3c 4abc*de 6d 7chtu 



WIC Prog--Ri verside Hosp 
Christine Wolf RD 
1600 N Superior 
Toledo OH 43604 
2ac 3c 4abce 6d 7nhm 



Ctr for Women/Children 

Preparation for Parenthood 

Monica Taylor 

Toledo Hosp 

3020 Marvin Ave 

Toledo OH 43606 

2c~3c 4abc*de* 6d 7bko 



Counseling for Problem 
Pregnancies Lutheran Soc Svc 
Nancy Yunker 
2149 Col 1 ingwood Blvd 
Toledo OH 43620 
2bc 3c 4abcdef 6d 7ihm 



Barnesville Hlth Svcs Assn 

Linda Phi 1 1 i ps 

Outreach Worker 

Hosp Dr 

Barnesville OH 43713 

2c 3ab 4b 6d 71 h 



Guernsey Cty Hlth Dept 
Mary Sorg LPN 
326 Highland Ave 
Cambridge OH 43725 
2bc 3c 4ab 6d 7ihmu 



WIC Prog--Coshocton Cty 

Hlth Dept 

Barbara Cal dwel 1 

Dir 

724 S 7th St 

Coshocton OH 43812 

2c 3b 4ab 6d 7nhm 



WIC Prog--Belmont Cty 

Bel laire Clinic 

3000 Guernsey St 

Bel laire OH 43906 

2d 3c 4abef 6bc 7nhkmu 



WIC Prog--Harr i son Comm Hosp 

Harrison Cty 

Barbara Poole RN 

951 E Market St 

Cadiz OH 43907 

2d 3c 4abe 6bc 7nhm 



147 



RESOURCES 



Ohio Valley Hosp Lamaze Classes 
Debbie Linn RN 
380 Summit Ave 
Steubenville OH 43952 
2c 3c 4ab 6bc 7ihm 



Continue Life Counseling Ctr 
Dianne Amon 

25100 Euclid Ave Rm 101 
Euclid OH 44117 
3ab 4b 6ab 7ihm 



Youngstown HI th Dept 
Martha Taylor RN MPH 
26 S Phelps Cy Hall 
Youngstown OH 44503 
2c 3c 4abc 6c 7kh 



Elyria Memorial Hosp 
Beatrice Plas RN 
630 E River St E 
Elyria OH 44035 
2c 3c 4abcde 6d 7bhmuv 



Elyria Cy HI th Dept 

Prenatal CI inic 

Betty Thome RN 

CI inic Mgr 

202 Chestnut St 

Elyria OH 44035 

2c 3ab 4abc* 6bc 7chu 



Parenting--Birth to Six 
American Red Cross/Lorain Cty 
2929 W River Rd 
Elyria OH 44035 
2d 3b 4abc 6bc 7kh 



Preschool Parenting Prog 
Sandra Gentry 
Child Develop Clement Ctr 
2500 E 79th St 
Cleveland OH 44104 
2c 3b 4ab 6d 7khmuv 



Families and Infants Together 

(FIT) 

Sharon K Yarnel 1 ACSW 

Case Western Reserve Unit 

Cleveland OH 44106 

2b 3ab 4abcd 6d 7abhkmu 



Hlthy Mothers/Healthy Infants 

Mol ly Brudnick 

ACSW Cleveland Hlth Dept 

1925 St Clair 

Cleveland OH 44114 

2d 3c 4ab 6d 7chmu 



Prepartion for Parenting S 

Parenting 

Carolyn A Randle 

American Red Cross/Cleveland 

1227 Prospect Ave 

Cleveland OH 44115 

2c 3ab 4a 6d 71 i hmu 



Barberton Hlth Dept 
Lena H Knight 
Cy of Barberton 
571 W Tuscarawas 
Barberton OH 44203 
2d 3c 4abce 6bc 7chikmu 



WIC Prog— Summit Cty Hlth Dept 
1 100 Graham Cir 
Cuyahoga Falls OH 44224 
2bc 3c 4abcde 6d 7nh 



WIC Prog—Portage Columbiana Cty 

Carol Zeltner 

449 S Meridian 

Ravenna OH 44266 

2d 3c 4abce 6d 7nh 



Summit Cty Child & Family 

Hlth Svcs 

Mary Pannel 

225 W Exchange St Rm 17 

Akron OH 44302 

2b 3c 4ab 6b 7chm 



Teenage Parents Ctr 

Judy Joyce 

Family Svcs of Summit Cty 

212 E Exchange St 

Akron OH 44304 

2c 3a 4ab 6bc 7abhkmuv 



Trumbull Cty Child 6 Family 
Hlth Svcs Clinic 
Beverly Lannon RN 
2577 Schenley Ave 
Warren OH 44483 
2c 3ab 4abc 6d 7ch 



Preparation for Parenthood 
Parenting, Age 1-6 Years 
Mahoning Cty American Red Cross 
266 W Wood St 
Youngstown OH 44502 
2b 3ab 4ab 6d 7kh 



WIC Prog — Mahoning Cty 
Darlene Stone 
312 N Walnut 

Youngstown OH 44505 
2d 3c 4abc*ef 6bc 7nhm 



Planned Parenthood/Mahoning 
Valley Panel of Parents 
Lindy Kirk RN BSN MS Ed NCC 
77 E Midlothian Blvd 
Youngtown OH 44507 
2d 3ab 4ab 6d 7jhkmu 



A-TEAM — Awareness Through 

Educ in Adolescent Maternity 

Trisha Merchant 

Teen D i r 

Massil Ion YM-YWCA 

131 Tremont SE 

Massil Ion OH 44646 

3a 4ab 6bc 7ah 



Holmes Cty Hlth Dept 
Carole Burkey 
2 Hospital Dr 
Millersburg OH 44654 
2c 3ab 4b 6d 7chu 



Planned Parenthood/Wayne Cty 
Cindy J Biggs 
26805 Cleveland Rd 
Wooster OH 44691 
2bc 3c 4abf 6ab 7jhu 



Mother/Child Hlth Clinic 
Comm Action/Wayne-Medina 
Carol Butira-Dulton 
2461 Bauman Dr 
Wooster OH 44691 
2d 3c 4abcdef 6d 7bh 



WIC Prog— Ashland Cty 

Patricia Beverage 

801 Orange St 

Ashland " OH 44805 

2bc 3c 4abc*e* 6d 7nhm 



148 



RESOURCES 



WIC Consortium — Crawford Cty 

Linda Laipply 

Dir 

112 E Mansfield St 

Bucyrus OH 44820 

2d 3c 4abcde 6bc 7nhm 



WIC Prog— Huron Cty Dept Hlth 

Iris Cozzie 

180 Milan Ave 

Norwalk OH 44857 

2bc 3ab 4abc*e 6bc 7nh 



WIC Prog--Seneca Cty Hlth Dept 

Jeanne Becker RN 

3100 S St Rt 100 

Tiffin OH 44883 

2d 3c 4abc 6b 7nh 



WIC Prog— Richland Cty 
Tina Pigman RD 
600 W 3rd St 

Mansfield OH 44903 
2c 3c 4abc*e 6bc 7nhm 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b • Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e ■ EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o • Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC Prog — Clermont Cty 
2209 Baver Rd 
Botavia OH 45103 
2d 3c 4abc*d 6d 7nhm 



Child 6 Family Hlth Svcs CFHS 

Hamilton Cty Network 

Brenda Coleman 

Hlth Svcs Dir 

Lincoln Heights Hlth Ctr 

1171 Adams St 

Lincoln HeightsOH 45215 

2d 3c 4abd 6d 7bhmu 



WIC—Northside Hlth Ctr 

Cincinnati Hlth Dept 

B Roley 

Nutrition Asst 

3917 Spring Grove Ave 

Cincinnati OH 45223 

2d 3c 4abc* 6d 7nhm 



Adolescent Obstetrical Svcs 
Janina Smoke CNM 
Univ Hosp of Cincinnati 
2236 Westwood NTN Blvd #B19 
Cincinnati OH 45225 
2c 3a 4ab 6bc 7a ih 



Child 6 Family Hlth Svcs 
Dr. John Ryan 
Cincinnati Hlth Dept 
3101 Burnet Ave 
Cincinnati OH 45229 
2cd 3a 4ab 6bc 7a 



Hlth Ed/Hlth Promotion Proj 

Smoking & Alcohol Pregnancy Cln 

Cynthia Blocksom 

Cincinnati Hlth Dept 

3101 Burnet Ave 

Cincinnati OH 45229 

2d 3c 4abcde 6b 7m 



Hlth Ed/Hlth Promotion Proj 
- Child Safety Seat Prog 
Cynthia Blocksom 
Cincinnati Hlth Dept 
3101 Burnet Ave 
Cincinnati OH 45229 
3c 4d 6bc 7k 



WIC Prog—Hamilton Cty 
Jeanne Arnold RD 
3101 Burnet Ave 
Cincinnati OH 45229 
2c 3ab 4abe* 6bc 7nhm 



Winton Hills Med Ctr 
Mari lyn Osborne 
5275 Winneste Ave 
Cincinnati OH 45232 
2c 3ab 4ab 6ab 7bahu 



WIC Prog— Preble Cty 
Theresa Williams RD 
119 S Barron St 
Eaton OH 45320 
2c 3c 4abe 6d 7nh 



Darke Cty Hlth Dept 

C Fourman RN 

OH Dept Hlth 

111 Delaware 

Greenville OH 45331 

2c 3c 4abc* 6d 7chkmu 



WIC Prog— Mercer Cty 

Jean Young 

Fami ly Hlth Svcs 

PO Box 747 

Greenville OH 45331 

2c 3c 4abc*e 6d 7nh 



WIC Prog— Miami Cty 

Theresa Taylor 

633 N Wayne St 

Pi qua OH 45356 

2bc 3c 4abc 6d 7nh 



Troy-Miami Cty Perinatal Clinic 

Charles Oxl ey MD 

Hlth Comm/Cl inic Dir 

P0 Box 677 

Troy OH 45373 

2d 3c 4abcdef 6d 7c 



Good Samaritan Hosp Hlth Ctr 
Prenatal Clinic 
Lamerial Daniels 
Dir Ambulatory Svcs 
2222 Philadelphia Dr 
Dayton OH 45406 
2c 3c 4abc* 6bc 7ihm 



EFNEP/OH Prog 

Expanded Food/Nutrition Ed Prog 

Emi ly W Brown 

Coop Ext Svc OH 

OH St Univ 1001 S Main St 

Dayton OH 45409 

2c 3c 4abce 6d 7dh 



149 



RESOURCES 



Combined Hlth Dist Montgomery 

Cty WIC 

Annie McDonald 

451 W 3rd St 

Dayton OH 45422 

2c 3c 4ab 6d 7nh 



Clarkton Cty Hlth Dept 
Judy Andrews RN 
301 S Fountain Ave 
Springfield OH 45506 
2d 3c 4abcde 6d 7cku 



WIC Prog— CAO of Scioto Cty OH 

Tammy Murray 

817 2nd St 

Portsmouth OH 45662 

2d 3c 4ab 6d 7nh 



Pike Cty Comm Action Family 

Hlth Ctr 

Rita Roberts RN CPNP 

215 W North St 

Weaver ly OH 45690 

2bc 3c 4ab 6d 71hkmu 



WIC Prog — Jackson Cty 

Rebecca Arers 

PO Box 71 

Wellston OH 45692 

2d 3c 4abce 6d 7nhm 



Adams Cty Prenatal Prog 

Andrew Filak MD 

Med Dir SOHSN 

9137 S R 136 

West Union OH 45693 

2d 3c 4b 6bc 7ih 



WIC Prog--Washington/Morgan Cty 

Sharon Frye RD 

696 Wayne St 

Marietta OH 45750 

2d 3c 4ab 6d 7nhm 



Allen Cty Hlth Dept 

Barbara A Beaver 

PO Box 1503 

Lima OH 45802 

2d 3c 4abc*e 6d 7chmou 



WIC Prog--Hancock Cty 
1000 W Main Cross 
Findlay OH 45840 
2d 3c 4abcde 6d 7nh 



WIC Prog--Paulding Cty 
Teresita S Sebastian 
101 W Perry St 
Paulding OH 45879 
2d 3c 4abc 6d 7nh 



Auglaize Cty Family Ping 
Nancy Stienecker RN 
Lima Wood St 

Wadakoneta OH 45895 
2d 3ab 4b 6ab 7jhu 



WIC Prog--WCD Enterprises 

Marcel la G Ruckman 

PO Box 247 

Anadarko OK 73005 

2c 3c 4d 6d 7nhm 



Cleveland Cty Hlth Dept 
Child Hlth Prog 
Bobbie Rei lley RNC 
641 E Robinson 
Norman OK 73071 
2d 3c 4abc*def 6c 7kh 



Idian Hlth Svcs/Nutri tion Br 
Ruth Hemberkides LRD MS MPH 
US Pub Hlth Svc 
215 Dean McGee St NW Rm 409 
Oklahoma City OK 73102 
2bc 3c 4d 6d 7gh 



American Red Cross 

OK Cty Chap 

Janice Phi 1 1 ips RN 

323 NW 10th ST 

Oklahoma City OK 73103 

2d 3c 4ab 6ab 7ihmu 



Adolescent Medicine Clinic 

J. Dennis Fortenberry 

MD 

940 NE 13th 

Oklahoma City OK 73104 

2d 3ab 4abcdef 6ab 7ahu 



Infant Ctr Univ OK Hlth 

Sarah Herstand 

Dir 

Svc Ctr 6 Junior League 

815 NE 15 

Oklahoma City OK 73104 

2c 3c 4abc*de 6c 7k 



OK Cy/Cty Hlth Dept Prenatal 

Clinic 

Jewel Buckingham RNC 

921 NE 23 

Oklahoma Cy OK 73105 

2c 3ab 4abc*e* 6bc 7ihu 



WIC/Well Baby Clinic 

OK Cy-Cty Hlth Dept 

Sammy Lou Eagy 

PHN III 

921 NE 23 

Oklahoma Cy OK 73105 

2d 3c 4abc*de*f* 6d 7nhijmtu 



March of Dimes Birth 

Defects Found 

Darlene Dunn 

6051 N Brookl ine Ste 126 

Oklahoma City OK 73112 

2d 3c 4abc*de 6d 7bhmru 



OKC Urban Indian Clinic 
Rhaelynn Bonham RNC 
1214 N Hudson 
Oklahoma Cy OK 73132 
2c 3c 4d 6d 7g 



Take Care of Your Baby 

Right from the Start 

Leslea Bennett-Webb 

OK Dept Hlth Educ Info Svc 

PO Box 53551 

Oklahoma City OK 73152 

2c 3b 4abcde 6d 7chmo 



Rural Infant Care Prog 

Univ OK Hlth Sci Ctr--0B/GYN 

Judith Morris RN MN 

PO Box 26901 

Oklahoma City OK 73190 

3c 4abcd 6bc 71 ht 



Maternal Child Hlth 

Maternity Prog 

Cynthia Baker RN 

Coord 

Ctr Cty Hlth Dept 

101 First SW 

Ardmore OK 73401 

2d 3c 4abc*de*f 6d 7bhmu 



Jackson Cty Hlth Dept 

Ruthy King RN 

201 S Lee 

Altus OK 73521 

2c 3ab 4abc* 6d 7cahu 



150 



RESOURCES 



Major Cty Hlth Dept 

Joye Gunsaul is 

PO Box 366 

Fairview OK 73737 

2c 3c '♦be* 6d 7chmu 



USPHS Indian Hosp 

Comm Hlth Nursing 

Meribeth Reed CHN 

Superv 

US Pub Hlth Svc 

Claremore OK 

2c 3c 4d 6d 7ghmu 



74017 



Indian Hlth Ctr 

RS Keshishian MS RD LD 

PH Nutritionist 

US Pub Hlth Svc 

PO Box 1-475 

Wewoka OK 7^884 

2c 3c 4d 6d 7ghm 



WIC Nutrition 6 Family Ping Prog 

Grant Cty 

J Cami 1 le Mock RN 

Coord Nurse 

Box 438 

Pond Creek OK 73766 

2d 3c 4abc*de* 6d 7nhmpt 



Oklahoma St Univ Coop Ext Svc 

Elaine Wi 1 son 

FRCD 

Stillwater OK 74078 

2c 3c 4abcde 6ac 7bhm 



WIC Prog--Clatsop Cty Hlth Dept 

Barbara Neff 

PO Box 206 

Astoria OR 97103 

2c -3c 4b 6d 7nhm 



Indian Hlth Svc 
HH Morgan RD 
USPH Nutritionist 
US Pub Hlth Svc 
Claremore OK 74017 
2b 3c 4d 6d 7ghmtu 



KEY 



Hlth Info Svc 

Tulsa Cy Cty Lib Sys 

Kel ly Jennings 

400 Civic Ctr 

Tulsa OK 74103 

3ab 4ab 6bc 7h 



Indian Hlth Care Resource Ctr 

Pamela E Dron 

915 S Cincinnati 

Tulsa OK 74119 

2d 3ab 4d* 6d 7ghmuv 



PRREP 

VA Garcia Mem Hlth Ctr 

Josie Yemone-bi rhane 

PO Box 302 

Cornelius OR 97113 

2d 3c 4abc* 6d 7i 



Immunization Ed Prog 
Berta Delman/Ronnie Meyers 
PO Box 70 

Portland OR 97207 
2bc 3c 4b*f 6c 7k 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic groupi si 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f- Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage* s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d- All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7e - Native American 
7n - Nutrition 
7i - Prenatal 
7i - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC Prog— Hashell Cty Hlth Dept 

Q Qi dwell RN 

PO Box C 

Stegler OK 74462 

2c 3ab 4b 6d 7nhmu 



WIC Prog—Cherokee Nation of OK 

Beth Nichols 

Nutrition Coord 

PO Box 948 

Tahlequah OK 74465 

2d 3c 4d* 6bc 7nh 



Comm Hlth Nursing 

Carl Albert Indian Hlth Fac 

Melba Apala RN CHN 

Coord 

PO Box 1564 

Ada OK 74820 

2d 3c 4bd* 6d 7ghmu 



Okemah Indian Hlth Clinic 

Raylene Pein RN PHN 

PO Box 429 

Okemah OK 74859 

2c 3c 4d 6d 7ghmtu 



Salvation Army White Shield Ctr 

Capt Sherry Ann Downs 

Admin 

P0 Box 10027 

Portland OR 97210 

2ac 3ab 4abcde 6d 7ahmpu 



Parent Chi Id Svcs 
Rosemary Hing 
909 NE 52nd Ave 
Portland OR 97213 
2d 3b 4abcde 6d 7khmu 



Hispanic Outreach/American Red 

Cross — Oregon Trai 1 Chap 

Berta Delman 

PO Box 70 

Portland OR 97213 

2d 3c 4c* 6d 7kh 



Portland Naturopathic Clinic 
Maternity Svcs 
Michael Anchorski MD 
11231 SE Market St 
Portland OR 97216 
2d 3c 4abcde 6d 7bhmu 



151 



RESOURCES 



EPSOT/OR Oept 

Human Resources 

HF Shellman 

203 Pub Svc Bldg 

Salem OR 97310 

2d 3c 4abc*def 6d 7e 



Hlth Care for Medically Needy 

OR Dept Human Resources 

CI iff Greenl ick 

203 Pub Svc Bldg 

Salem OR 97310 

2d 3c 4abc*def 6d 7c 



WIC Prog--A1 legheny Cty Hlth 

Dept 

Dorothy C Kolodner 

Chief Nutritionist Svcs 

Cty Ofc Bldg Rm 518 

Pittsburgh PA 15219 

2d 3c 4abde* 6d 7nh 



Bench Women's Hlth Network 

of the Hlth Ed Ctr 

Lori s Mielbal 1 

200 Ross St 

Pittsburgh PA 15219 

2c 3a 4a 6ab 7ah 



Cameron Cty Hlth Care Ctr 

Stephanie Rindash 

PO Box 270 

Emporium PA 15834 

2bc 3a 4b 6ab 7chu 



Aff i 1 iate Devel of 

Adoles Pregnancy/Parent Prog 

Deanna M R Yarboro 

Couns Consultant 

Shenango Valley Urban League 

314 Idaho St 

Farrell PA 16121 

2c 3a 4ab 6d 7ahku 



EFNEP--0R St Univ Ext Svc 

Margaret Lewis 

US Dept Agric 

31 Milam Hall 

Corvallis OR 97331 

2d 3c 4abc*def* 6d 7dh 



Josephine Cty Prenatal Prog 

Gaven E Bowman 

Nursing Svc Mgr 

714 N St 

Grant Pass OR 97526 

2d 3c 4abcdef 6bc 7chimu 



HI thy Mother Healthy Baby 

Fami ly Fair 

Charlotte Krai 1 

NEw Kensington Hlth Ctr 

1260 Martin Ave 

New Kensington PA 15068 

2d 3ab 4ab 6d 7b 



Adults in Transition 

PA St Uni v-Kensington 

Chele McArdle 

3550 7th St Rd 

New Kensington PA 15068 

2d 3c 4abcde 7khmv 



Time Together 
Suzanne Riggle RN 
701 Chartiers Ave 
McKees Rocks PA 15136 
2d 3c 4ab 6d 7kv 



Tel-A-Teen/Tel-Aid--Hlth Ed Ctr 

200 Ross St 

Pittsburgh PA 15219 

2bc 3ab 4abcdef 6d 7ahmu 



Comp Svcs Prog for Unmarried 
Parents Single Parent Fam 
James V Denova ACSW 
Dir Prof Svcs 

Catholic Charities of Pittsburgh 
307 4th Ave Ste 300 
Pittsburgh PA 15222 
2c 3ab 4ab 6bc 7b 



Comp Materni ty Svc Proj 

Donna M Proctor 

Proj Dir 

Family Hlth Ctr WPA 

625 Stanwix St 

Pittsburgh PA 15222 

2c 3ab 4ab 6abc 6ihmu 



WIC Prog--Family Hlth Counc W PA 
Natalie V Guiler MS RD 
625 Stanwix St Ste 1201 
Pittsburgh PA 15222 
2d 3c 4abc*de* 6d 7nhm 



WIC Prog--Washington-Greene 
Comm Action 
Maryann Morvetz 
WIC Operations Mgr 
2198 N Main St 
Washington PA 15301 
2d 3c 4ab 6d 7nhm 



WIC Prog--FCCAA Fayette Cty 
Carmel i ta Clark 
48 E Church St 
Uniontown PA 15401 
2bc 3c 4ab 6d 7hm 



Hyndman Area Hlth Ctr 

Diane Hofman 

PO Box 507 

Hyndman PA 15545 

3ab 4b 6b 7ih 



WIC Prog — Armstrong Cty 

Karen Virostek 

1422 5th Ave 

Ford Cy PA 16226 

2b 3ab 4ab 6bc 7nhm 



Meadvil le St Hlth Ctr 

PA Dept Hlth 

Al ice E Bowden RN 

Pub Hlth Nurse Dir 

900 Water St Downtown Mall 

Meadville PA 16335 

2d 3c 6c 7khm 



WIC Prog—Comm Hlth Svcs 

Lorie Wal Is RD 

Coord 

533 State St 

Meadville PA 16335 

2d 3ab 4abce 6d 7nhm 



Warren St Hlth Ctr 

Barbara A White RN 

PA Dept Hlth 

621 Pennsylvania Ave E 

Warren PA 16365 

2d 3c 4b 6bc 7chmuv 



WIC Prog--Broad Top Area Med Ctr 

Nancy Ritchey 

Nutri tioni st 

Box 127 

Broad Top PA 16621 

2bc 3c 4ab 6bc 7nhm 



Glendale Med Ctr 

Stephanie Rindosh 

PO Box 401 

Coal port PA 16627 

2c 3b 4b 6d 7i 



152 



RESOURCES 



Tri-Ctr Midwifery Svc 
Susan Baker CNM 
JC Blair Mem Hosp 
Huntington PA 16652 
2d 3c 4abc 6d 7fhmu 

WIC Prog—Miff 1 in/Juniata 

Wi 1 la Adams 

Nutr i tionist 

3N Dorcas St 

Lewistown PA 17044 

2bc 3c 4b 6d 7nh 

Lourdes House 
Cathol ic Soc Svcs 
Cleona G Davenport 
1611 Boas St 

Harrisburg PA 17103 
2bc 3ab 4ab 6bc 7ih 

PA Dept HI th Div Maternal/Child 

Hlth Maternity Prog 

Christine E Carson 

PO Box 90 

Harrisburg PA 17108 

2d 3c 4abcdef 6b 7cahmuv 



KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d ■ all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian'Pacific Islander 

4f- Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Hamilton Home Hlth Agy 
Jean Fleming RN 
1821 Fulton St P0 Box 5098 
Harrisburg PA 17110 
2c 3ab 4abcde 6bc 7bhu 



SE Lancaster Hlth Svcs 

Phi 1 i p Starr 

PO Box 598 

Lancaster PA 1 7603 

2d 3c 4abc*e 6abc 7bhmu 



American Red Cross/Lancaster Cty 

Kay M Crawford RN 

Dir Nursing/Hlth 

430 W Orange St 

Lancaster PA 17603 

2d 3c 4abc*de 6d 7h 



PA Dept Hlth 
Noth Central Dis 
Hannah K Klein RN C 
Dist Nurse Admin 
734 W 4th St 

Williamsport PA 17701 
2b 3ab 4b 6c 7cv 



HI thy Baby Week 

Veronic Fogelman 

Dir 

Ctl PA Lung/Hlth Svc Assn 

531 W 4th St 

Williamsport PA 17701 

2bc 3ab 4b 6ab 7ihm 



WIC Prog--Bi-Cty 

Ann Reeves 

Coord 

625 W Edwin St 

Williamsport PA 17701 

2d 3c 4abc*de* 6d 7nhm 



La Leche League 
Pocono Mountain 
Rosemary LangKammer 
Box 149 RD1 

Tobyhanna PA 18466 
2d 3c 4abcde*f* 6d 7o 



Northeastern Dist PA Dept of 

Hlth 

Ronald G Masi tis 

Dist Exec Dir 

383 Wyoming Ave 

Kingston PA 18704 

2d 3c 4abc* 6d 7ch 



Adoles Hlth S FAMLEE— Fathers & 

Mother Learning by Ed Experi 

Ann Duerst RN 

Quakertown Comm Hosp 

11th & Park Ave 

Quakertown PA 18951 

2c 3ab 4b 6d 7iahmu 



Delaware Cty Home Hlth Svcs 
Jacqueline Blundin RN BSN 
422 E 22nd St 
Chester PA 19013 
2d- 3c 4abc 6d 7bhmp 



Hlth Educ Associates 
21 1 S Easton Rd 
Glenside PA 19038 
2d 3c 4abc*de 6bc 7ko 

Ches Penn Hlth Svcs 
1300 W 9th St 
Chester PA 19064 
2d 3c 4abc* 6c 7kh 

CHOICE— Concern for Hlth 
Options Info Care & Ed 
Maryann Mesure 
1501 Cherry St 
Philadelphia PA 19102 
2b 3c 4ab 6b 7ihm 



Parents & Teens Together 
Warner B Rodgers 
Urban League of Phi la 
1930 Chestnut St #200 
Philadelphia PA 19103 
2bc 3a 4abc* 6a 7ajv 



Family Ctr 
Loretta Finnegan MD 
Thomas Jefferson Univ Hosp 
111 S 11th St Rm 6105 NH 
Philadelphia PA 19107 
2bc 3c 4abc* 6d 7bhmu 



Maternal /Infant Care Prog 
Med Col 1 of PA 
Mol ly Kel logg MS RD 
3300 Hensy Ave 
Philadelphia PA 19129 
2bc 7ac 4abc 6b 7o 



Pediatric Group Svcs 
Med Col 1 PA 
Herberta Smith RN PNP 
3300 Henry Ave 
Philadelphia PA 19129 
2c 3c 4abc*e 6c 7k 



153 



RESOURCES 



Cy of Philadelphia Maternity 

and Infant Care Prog 

Lucil le N Mai im 

Admin Div Maternal/Child Hlth 

500 S Broad St 

Philadelphia PA 19145 

2d 3c 4abc*de*f 6d 7bhjuv 



WIC Prog — Comm Gen Hosp 

L Schneider RN 

145 N 6th St 

Reading PA 19601 

2c 3c 4abc* 6bc 7nh 



Baby & Chi Id Care 

American Red Cross/Berks Cty 

701 Centre Ave 

Reading PA 19601 

3a 4abc 6c 7kh 



Adolescent Pregnancy Prog 

Judith Druckenmi 1 ler 

March of Dimes 

412 Penn Ave 

W Ridge PA 19609 

2bcd 3a 4abc*de 6d 7aigkhum 



Patillas Rural Hlth Initiative 

Ctr 

Socorro Antura 

Comm Couns 

Box 697 

Patillas PR 00723 

2d 3c 4abc* 6bc 71 h 



Prenatal Svcs— Dept Hlth Family 

Hlth Svcs 

Nitza Medina 

Call Box 70184 

San Jusn PR 00936 

2d 3ab 4c* 6b 7i 



BVCAP Hlth Ctr 

Joanne Moran 

Asst Oir 

Blackstone Valley Comm Act Prog 

44 Perry St 

Central Falls Rl 02863 

2c 3c 4bc* 6d 7bhkmu 



Providence Ambulatory Hlth 
Care Found 
Lynn Spector 
Assoc Dir OB/GYN 
469 Angel 1 St 
Providence Rl 02906 
2d 3c 4abc*de* 6d 7ahmu 



Perinatal Outreach Prog 
Martha Warburton RN 
Women £ Infants Hosp 
50 Maude St 

Providence Rl 02908 
2d 3c 4abce 6b 7abhimu 



New Di rect ions 
Mary Dowd Struck 
Women & Infants Hosp 
50 Maude St 

Providence Rl 02908 
2c3a 4abcde 6abd 7abhmu 



WIC Prog--RI Dept Hlth 

John L Smith 

Chief 

Rm 403 Cannon Bldg 75 Davis St 

Providence Rl 02908 

2d 3c 4abc*de*f* 6d 7nhm 



WIC Prog--Women & Infants Hosp 
Doreen Chin Pratt MS RD 
Dir Nutrition Svcs 
50 Maude St Amb 506 
Providence Rl 02908 
2d 3ab 4abc*de*f* 6bc 7nh 



Branberg Nurse-Midwifery Svc 

L L Wood CNM 

PO Box 528 

Barnberg SC 29003 

2d 3c 4ab 6d 7fhmu 



Lee Med Practice 
Donna E. Humphries LPN 
PO Box 508 

Bishopville SC 29010 
2d 3c 4ab 6d 7bhmu 



Comm Prenatal Classes — 

Clarendon Cty Hlth Dept 

Dorothy E McFadden RN 

Cty Nursing Superv 

SC Dept Hlth/Environ Control 

3 Church St 

Manning SC 29102 

3c 4ab 6bc 7ihmu 



Preconceptional Intervention 

Proj Lower Savannah II Hlth Dist 

Carolyn M Banner 

PO Box 940 

Orangeburg SC 291 15 

2c 3c 4ab 6a 7jhmtu 



Maternal-Child Prog 

Shirley James 

PO Box 940 

Orangeburg SC 291 1 5 

2c 3c 4ab 6bc 7ch 



Low Risk Maternity Prog 

Hlth Dept 

Lula C Davenport RN FP 

Maternity Prog Nurse Specialist 

Sumter Cty Htlh Dept 

PO Box 1628 

Sumter SC 29150 

2d 3c 4abe 6d 7chmu 

Div Maternal Hlth 

SC Dept Hlth/Environ Control 

Joanne G Frasen 

MCH Hlth Ed Cons 

2600 Bull St 

Columbia SC 29201 

2d 3c 4ab 6b 7ihmu 



E Midlands Hlth Dist 

SC Dept Hlth/Environ Control 

Lynda Kettinger 

1221 Gregg St 

Columbia SC 29201 

2c 3c 4ab 6a 7jhmv 



EFNEP— Univ Rl Coop Ext Svc 

Martha S Patnoad 

US Dept Agric 

130 Woodward Hall Univ Rl 

Kingston R| 02881 

2d 3c i»abc*de 6d 7dh 



Medicaid Eligibility Div 

SC Dept Soc Svcs 

Donald Graves 

Box 1520 

Columbia SC 29202-1520 

2c 3c 4abc*f* 6d 7ehmu 



154 



RESOURCES 



SC Comm on Alcohol S Drug Abuse 

Jim Neal 

3700 Forest Dr 

Columbia SC 29204 

2d 3c 4abd 6ab 7m 

Childrens Bureau of SC 
1001 Harden St Ste 225 
Columbia SC 29205 
2d 3c 4abcde 6d 7bhmu 

Preparation for Parenthood 
Parenting Classes 
Beverly Weymouth RN 
American Red Cross/SC 
Box 5495 

Columbia SC 29250 
3c 4ab 6c 7b 

Appalachia I I I Hlth Dist 

Maternity Prog 

Sarah Sease 

SC Dept Hlth/Env Control 

PO Box 4217 

Spartanburg SC 29305-4217 

2d 3c 4abe 6ab 7c i 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 



7g - Native American 
7h-l 



Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 
7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC/Nutri tion Svcs--Appalachia 

II I Hlth Dist 

El i zabeth Wheby 

Dist Nutritionist/WIC Coord 

PO Box 4217 

Spartanburg SC 29305-4217 

2d 3c 4abc*e* 6d 7nhm 



Trident Hlth Dist Prenatal 

Ed Classes 

Ben Tolomea 

Charleston Cty Hlth Dept 

334 Calhoun St 

Charleston SC 29401-11! 

2bc 3ab 4ab 6d 7ihmt 



Med Univ of SC 

Dept of Family Medicine 

Dena Clair RN 

Nurse Educ 

171 Ashley Ave 

Charleston SC 29425 

2e 3c 4abe 6d 7bhmv 



SC Low Birthweight Prevention 
Prog Med Univ SC OB/GYN Dept 
Henry C Heins MD 
171 Ashley Ave 
Charleston SC 29425 
2d 3c 4ab 6b 7ihmt 



McLeod Family Practice 
Amanda H Coleburn 
555 E Chives St 
Florence SC 29501 
2b 3a 4ab 6bc 7ahu 



Florence Cty Comm Alcohol 

6 Drug Abuse 

Donna George 

Pub Info & Ed Spec 

PO Box 4881 

Florence SC 29502 

6b 7m 



Horry Cty Hlth Dept 
3811 Walnut St 
Loris SC 29569 
2d 3c 4ab 6bc 7chu 



Sunbelt Human Advancement 
Resources (SHARE) 
Dorothy B Mims 
Dir Comm Svcs Div 
PO Box 10204 FS 
Greenville SC 29603 
2c 3c 4ab 7hk 



OB/GYN Clinic 

Sh i r 1 ey Moody 

Greenvi 1 le Hosp Sys 

701 Grove Rd 

Greenville SC 29605 

2d 3c 4abcde 6d 7bhmu 



Smoking Cessation Prog/Prenatal s 

Appalachia Pub Hlth Dist 

Sara Jo Moore 

Dist Hlth Ed 

PO Box 1906 

Anderson SC 29622 

2b 3b 4b 6b 7m i 



Oconee Mem Hosp 

Patricia Rutledge 

Dir Educ 

Box 858 

Seneca SC 29678 

2c 3c 4ab 6c 7kh 



HI thy Mothers/Healthy 

Babies Coal i tion 

Deedy Smith 

SC Dept of Hlth 

PO Box 3057 CRS 

Rock Hill SC 29730 

2c 3a 4abde 6a 7a 



Hlth Dept Prenatal Prog 
1243 Ebenezer Rd 
Rock Hill SC 29731 
2d 3c 4abc*de* 6b 7ihmu 



Dept Hlth/Environ Control 
Lower Svannah Dist I 
Barbara B Kemp ACSW 
828 Richland Ave 
Aiken SC 29801 
2d 3c 4ab 6b 7ihj 



MEGALS Rural Hlth Assn 

Linda B Hudson 

PO Box 219 

Trenton SC 29847 

2c 3b 4ab 6b 71 



Welcome Baby Prog--Child 

Abuse Prev Assoc 

Shirley Sutton 

Pres 

PO Box 1933 

Beaufort SC 29901 

2bc 3c 4abce 6c 7kh 



155 



RESOURCES 



WIC Prog--Maternal/Child Hlth 

Low Country Hlth Dept 

Ann Rickard RD 

PO Box 1479 

Beaufort SC 29902 

2bc 3c 4abc* 6d 7nh 



WIC Prog--Potter Cty Comm Hlth 
Claine A Wheeler 
200 W Commercial 
Gettysburg SD 57442 
2c 3c 4bd 6d 7nhm 



Positive Parent Network 

Linda Wei Is 

PO Box 2792 

Rapid City SD 57709 

2d 3c 4abcd 6bc 7k 



Beaufort-Jasper Comp Hlth Svcs 

Roland J. Gardner 

Box 357 

Ridgeland SC 29936 

2c 3c 4abc 6d 7bhu 



Lincoln Cty Pub Hlth 

Kay Reed-Moen RN 

Admin 

100 E 5th 

Canton SD 57013 

2c 3ab 4b 6bc 7o 



Smoking 6 Pregnancy 

SD Lung Assn 

Kathleen Wiebers 

Exec Dir 

208 E 13th St 

Sioux Falls SD 57102 

3ab 4d 6d 7m 



Grant Cty Comm Hlth 

Joan Frerichs RN 

210 E 5th Ave 

Mil bank SD 57252 

2c 3b 4b 6bc 7ch 



WIC Prog 

Box 67 

Howard SD 573*»9 

2c 3ab 4b 6bc 7nh 



WIC Prog--Aurora Cty Hlth Nurse 

M Swent RNC 

Box 502 

Plankinton SD 57368 

2c 3c *4b 6c 7nhm 



Di scover Your Chi Id 

St Lukes Hosp 

Deb Hofer 

305 S State 

Aberdeen SD 57401 

3c 4bd 6c 7k 

Comm Hlth Nursing 
Marshal 1 Cty Comm Hlth 
Box 82 

Britton SD 57*00 
3c 4bd 6d 7h 



SD Dental Assoc/SD Dept of Hlth 

P0 Box 119 1 * 

Pierre SD 57501 

2d 3c 4abd 6c 7qh 



SD Maternal/Child Hlth Prog 

Sandra Durick 

523 E Capitol 

Pierre SD 57501 

2c 3ab 4abcde 6c 7kh 



Emergency Med Svcs 

SD St Hlth Dept 

Susan Schuurmans 

523 E Capitol 

Pierre SD 57501 

3a 4abcd 6c 7kav 



MCH Prog— SD Dept Hlth 

Al len W Krom 

523 E Capitol 

Pierre SD 57501 

2d 3c 4abcd 6d 7ch 



WIC Prog—Rosebud Sioux 

Roslyn Bolger 

Box 99 

Rosebud SD 57570 

2c 3ab 4d 6d 7nh 



WIC Prog— Cheyenne 

River Sioux 

Cynthia Red Dog 

WIC Dir 

Box 550 

Eagle Butte SD 57625 

2c 3c 4bd 6d 7nhmu 



WIC Prog— Comm Hlth Nursing 

Col leen Mi 1 ler 

Box 82 

Faith SD 57626 

2c 3c 4b 6d 7nhmu 



SD Dept Hlth/Nutrition Svcs 
Linda Marchand 
725 North LaCrosse 
Rapid City SD 57701 
2c 3c 4bd 6d 7h 



WIC Prog 
MK Hulit RN 
906 N River 
Hot Springs SD 
2d 3c 4bd 6bc 7nh 



577^7 



Sumner Cty Hlth Dept 
Mitzi Wilhite 
411 S Water St 
Gallatin TN 37066 
2d 3c 4ab 6d 7chiku 



Warren Cty Infant Fol low-Up Prog 
Brenda Hoi land RN 
1345 Sparta Hwy 
McMinnville TN 37110 
2d 3c 4abc 6bc 7kh 

Hlthy Children Infant Fol low- 
Up 

Shannon Horn RN 
Cannon Cty Hlth Dept 
Lehman St 

Woodbury TN 37190 
2d 3c 4ab 6d 7khmu 

American Lung Assn/TN 

Wi 1 1 iam F Busse 

PO Box 399 

Nashville TN 37202 

2c 3c 4ab 6b 7m 



EPSDT Outreach/Metro Hlth Dept 

Nashville-Davidson Cty 

Stan Romine 

311-23rd Ave N 

Nashville TN 37203 

3c 4abcde 6bc 7ce 



Metropolitan Hlth Dept 
Prenatal Clinic 
Betty Y Garbutt CNM 
311 23rd Ave N 
Nashville TN 37203 
2d 3c *»abe* 6bc 7ihmu 



156 



RESOURCES 



Preparation for Parenthood/ 

Nashville Area Red Cross 

Sara Marquardt 

American Red Cross/Nashville 

321 22nd Ave 

Nashville TN 37203 

2ab 3b 'tab 6bc 7bhm 

Matthew Walker Hlth Ctr 
Bhag S Kanwar 
1501 Herman St 
Nashville TN 37208 
2c 3c 4ab 6d 71htu 

Maternal S Infant Care Proj 
Martha A Burton 
Metro Nashville Gen Hosp 
72 Hermitage Ave 
Nashville " TN 37210 
2c 3ab 4abe 6bc 7bhk 

TN Statewide Prenatal Prog 

Pauline S Mclntyre RN CN 

MCH 

100 9th Ave N 3rd Fl 

Nashville TN 37219 

2d 3c *»abc*def 6bc 7ihmu 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f- Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal parenting 
71 - Rural 
7m - Substance use 
7r, - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



WIC 10th Anniversary Pub 

Awareness Campaign 

Jane Baxter 

WIC Coord 

TN Dept Hlth/Environ — Nutrition 

100 9th Ave N 

Nashville TN 37219 

2c 3ab 'tabcde 6bc 7nh 



TN Dept Hlth/Environ--Dental Div 

James Newman 

100 9th Ave N 

Nashville TN 37219-5^05 

2bc 3ab Aabc 6bc 7qh 



Hlthy Children Initiative 

TN Dept Hlth/Environ 

Jan Scanlon 

100 9th Ave S 

Nashville TN 37219-5^05 

2b 3ab 4ab 6bc 7k 



Maternal Infant Hlth Outreach 

Worker Proj/Vanderbi 1 t Univ 

Barbara CI i nton 

Assoc Dir Ctr Hlth Svcs 

Sta 17 

Nashville TN 37232 

2c 3ab **ab 6d 71 hm 



McMimi Cty Prenatal Prog 

Melva Green RN 

PO Box 665 

Athens TN 37303 

2d 3c *tabef 6bc 7ihmu 



East Side Day Sch 
Kathryn Drake 
323 High Sr 

Chattanooga TN 37^03 
2c 3a **ab 6abc 7ahu 



Parent Chi Id Ctr 
Wanda Judd 

US Dept Hlth/Human Svcs 
10^3 Blackford St 
Chattanooga TN 37^03 
2d 3ab *»a 6c 7kh 



WIC Prog— TN 

Terri Crider 

WIC Dir 

921 E 3rd St 

Chattanooga TN 37^03 

2d 3c *tabc*de* 6bc 7nhm 



Hlth Promotion/Disease Preven 
Dodson Ave Hlth Ctr 
1200 Dodson Ave 
Chattanooga TN 37 2 *06 
3ab 4ab 6ab 7ahmot 



Southeast Region Nutrition Svcs 

Marguerite Moses 

Nutrition Dir 

TN Dept Hlth Environ 

2501 Milne St 

Chattanooga TN 37^06-3399 

2d~3ab *tabc* 6d 7hm 



Sul 1 ivan Cty Hlth Dept 
Ellen Gray RN 
PO Box 630 

Blountville TN 37617 
2d 3c 4ab 6d 7chmu 



Laurel Fork-Clear Fork 

Hlth Ctrs 

Shirley Parker 

Exec D i r 

General Delivery Hwy 90 

Clairfield TN 37715 

2d 3c ^abc 6d 7bhm 



Union Graingn Primary Care 
Connie Kl ini f i Iter 
Comm Outreach 
PO Box 1033 

Naynardville TN 37807 
2bc 3c hb 6d 7bhu 



TN Dept Pub Hlth — Reproductive 
Hlth Svcs 
Emma Penson RN 
1522 Cherokee Trail 
Knoxville TN 37901 
2c 3c 4ab 6d 7chmu 



American Red Cross/Knox Cty 

Nan Coleman RN 

Dir Nursing/Hlth Svcs 

PO Box 2026 

Knoxville TN 37901 

*tab 6c 7k 



Chi Id & Fami ly Svcs 
Charles E Gentry 
1 1A Dameron Ave 
Knoxville TN 37917 
2d 3ab *»ab 6c 7khv 



157 



RESOURCES 



MLB Clinic Knox Cty HI th Dept 
Louise K Morgan RN 
2247 Western Ave 
Knoxville TN 37921 
2c 3ab 4ab 6c 7k 



Florence Crittenton Agy 

Rush B Winchester MD 

Exec Dir 

PO Box ^+09^ 

Knoxville TN 37921 

3c 4abcdef 6ab 7ihmu 



Rossvil le Hlth Ctr 

Marsha S Anderson 

PO Box 249 

Rossville TN 38066 

2c 3c 4ab 6d 7ihu 



Maternal - I nfant-Hl th-Out reach- 
Worker (Ml HOW) Proj 
Minnie Bommer 
Douglas Comm Hlth Clinic 
PO Box 276 

Stanton TN 38069 
2c 3c 4ab 6d 71 hm 



Methodist Hosp of Memphis 
Kathleen Strausser 
Nursing Staff Develop 
1265 Union Ave 
Memphis TN 38104 
2c 3c 4abe 6d 7bhm 



Hlthy Children Initiative 
TN Dept Hlth/Environ 
Jean Davis RN MA 
Putnam Cty Hlth Dept 
121 S Dixie 

Cookeville TN 38501 
2d 3c 4abcdef 6bc 7khmu 



Upper Cumberland Reg Ofc 

Hlth/Environ 

Trudy Braun 

PO Box 5033 

Cooksville TN 38501 

2c 3ab 4b 6d 7a 



Hlthy Children 

White Cty Hlth Dept 

Kathy Clark 

Box 509 

Spartus TN 38583 

2d 3c 4ab 6bc 7h 



Preparation for Parenthood 
Parenting Your Child — 1-6 
Jane B Hendrix RN 
2300 McKinney Ave 
Dallas TX 75201 
2bc 3c 4abcde 6d 7bhikmu 



Salvation Army Soc Svc Ctr 
2215 N Akard 

Dallas TX 75201 
2d 3c 4abc*d 6d 7b 



Life Planning/Hi th Svcs 

Walter Ostergren 

Pres/CEO 

2727 Oak Lawn Ste 228 

Dallas TX 75219 

2d 3ab 4abc 6d 7ihu 



John Peter Smith Hosp 
Diana Clokey MS RD 
1500 S Main St 
Ft Worth TX 76133 
2bc 3ab 4abc*e 6b 7ih 



Wichita Falls-Wichita Cty 

Pub Hlth Dist 

Barbara J Clements 

1700 3rd 

Wichita Falls TX 76301 

2c 3c 4abc*e 6d 7chmuv 



Cross Timbers Hlth Clinics 

Karol Wilhelm RN 

Box 30 

DeLeon TX 76444 

2d 3c 4bc* 6d 7khu 



Jefferson Davis Childbirth 

Educ Assoc (JDCEA) 

Roni Archer 

Pres 

1801 Allen Pkwy 

Houston TX 77019 

2d 3c 4abc*de 6bc 7bhmo 



Prenatal Prog 

Jann Bel ton 

Memphis/Shelby Cty Hlth Dept 

8l4 Jefferson Ave 

Memphis TN 38105 

2bc 3c 4abe* 6d 7chmu 



Preparation for Parenthood for 

Adoptive Parents 

Jane B Hendrix RN 

2300 McKinney Ave 

Dallas TX 75201 

2c 3c 4ab 6c 7k 



Prenatal /Chi Id Hlth Educ Prog 
Cy Houston Hlth Dept 
Kathryn J Gardner RN MPH 
1115 N MacGregor 
Houston TX 77030 
2c 3ab 4abc*e 6d 7chmuv 



WIC Prog--NW Reg Hlth Ofc 
PO Box 190 

Union Cy TN 38261 
2d 3c 4ab 6bc 7nhm 



WIC/Prenatal/Fami ly Ping Clinics 

Maury Cty Hlth Dept 

Nancy Penroo 

Pub Hlth Nurse 

1220 Trotwood 

Columbia TN 38401 

2bc 3ab 4ab 6d 7nh 



Los Barrios Unidos Comm Clinic 

Ruthann Wyrostka 

3316 Sylvan Ave 

Dallas TX 75212 

3c 4abc* 6d 7b 



Womens & Childrens Hlth Care 
Sulabha Hardikar MD 
Cy Houston Hlth Dept 
1115 N MacGregor 
Houston TX 77030 
2c 3ab 4abc*e* 6d 7chmuv 



WiC Prog--Walker Cty Hlth Dept 

Margaret Lovel 1 

Nutr i t ionist 

919 Hwy 75 N 

Huntsville TX 77340 

2d 3c 4abcdef 6d 7nh 



158 



RESOURCES 



Infant Stimulation Prog 

Comm Svcs 

Nan Hoidal 

Richmond St Sen 

2100 Preston 

Richmond TX 77469 

2d 3c 4abc*de*f 6d 7khj 

Great Expectations 

Kathie Moers RN 

Ft Bend Ofc Early Child Develop 

902 Morton 

Richmond TX 77469 

2d 3c 4abc*e 6d 7jh 

Galveston Cty Hlth Dist 

The 1 ma Logan RN 

P0 Box 939 

La Margue TX 77568 

2d 3c 4abc*e* 6d 7chjmu 

Port Arthur Hlth Dept 

M&CH/WIC Div 

Rosemary Hanicak 

PO Box A 

Port Arthur TX 77641 

2d 3c 4abc*e* 6d 7chmu 

KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 
2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Prepregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u • Sexually transmitted diseases 
7v - Life skills 



Genetics Screening & Couns Svc 

Toye Babb 

Box 38^6 

Beaumont TX 77704 

2c 3c 4abc* 6d 7ihr 



TX Agric Ext Svc Nutrition 

Ed Prog 

Lynn White 

Family Sciences Proj Superv 

US Dept Agric 

Special Svc Bldg TAMU Rm 203 

College Sta TX 77843-2141 

2bc 3c 4abcdef 6d 7nh 



Jackson Cty Hlth Dept 
411 N Wells St 
Edna TX 77957 

2d 3c 4abc* 6d 7bhu 



Laredo State Ctr 

Delores V Rodriguez 

Dir 

PO Box 1835 

Laredo TX 78044-1835 

2d 3c Ac* 7m 



WIC Prog--Atascosa (RHI) 
Hlth CI inic 
Judy Lindsey RN 
310 W Oaklawn 
Pleasanton TX 78064 
2b 3b 4bc* 6d 7nh 



WIC Prog--San Antonio 

Hlth Dist 

Mary Lou Quijano RN 

2322 Buena Vista 

San Antonio TX 78207 

2d 3c 4abc*de 6bc 7nh 



Travis Park Infant 

Nutrition Prog 

Nancy Schweers 

744 Eventide 

San Antonio TX 78209 

2d 3c 4abc* 6d 7o 



Brownsville Comm Hlth Clinic 
Maternity Ctr 
Mary El len O'Brien CNM 
2137 E 22nd St 
Brownsville TX 78250 
2c 3c 4c* 6d 71bhotu 



Proj ABC--Any Baby Can 

Childrens Hosp 

Marian Sokol 

Proj Dir 

PO Box 7330 Stn A 

San Antonio TX 78285 

2c 3c 4abc*de 6c 7k 



Corpus Christi Cty 

Hlth Dept 

Helen Reeves RN 

1702 Home Rd 

Corpus Christi TX 78416 

2d 3c 4abc*e 6d 7chmu 



Urgent Supplemental Assistance 

USA 

Margarita Trevino-Rodr i guez MS 

Hidalgo Cty Hlth Care Corp 

PO Box 5803 

McAllen TX 78501-02 

2bc 3c 4c* 6bc 7hmo 



Infant Nutrition/Care Project 
Janet Taylor-Lehman MS RD LD 
Brownsville Comm Hlth Ctr 
2137 E 22nd St 
Brownsville TX 78520 
2d 3c 4bc* 6d 7o 



Brownsville La Leche League 

Cy Clinic Prog 

Lee Lopez 

1 10 Ebony Ave 

Brownsville TX 78520 



2c 3c 4bc 6bc 7o 



Su CI ini ca Fami 1 i ar 

Brownsvi lie Clinic 

Rosalinda Gonzalez 

RN CFNP 

FM 511 4000 

Brownsville TX 78520 

2b 3c 4c* 6ac 71hmu 



Su CI inica Fami 1 i ar 

Rosa Ambruiz 

Hlth Educ 

1314 Ed Carey Dr 

Harlinger TX 78550 

2d 3c 4abc 6d 7ahimu 



Holy Fami ly Svcs 
Kristy Higgs RN 
Route 1 Box 257 
Weslaco TX 78596 
2c 3c 4c 6bc 7bhiko 



159 



RESOURCES 



TX Dept Hlth Nutrition Svcs 

Nancy Robi nett-Wei ss MS RD LD 

Dir 

Nutrition Svcs 

1100 W 49th St 

Austin TX 78756 

2ab 3c 4abc*e 6bc 7nh 



Mother Care Is Baby Care 

TX Dept Hlth 

Pamela Felker 

Div Pub Hlth Promo 

1100 W 49th St 

Austin TX 78756 

2b 3b 4abc* 6b 7ihmu 



Early Childhood Intervention 
TX Interagency Counc/ECI 
Mary Elder 



Admin 

1100 W 49th 

Austi n 

2d 3c 4abc*def 



78756 
7k 



Oral Hlth Teaching Guide for 

Mother and Chi Id 

Cheryl Aiel lo MSHP 

Dental Hlth TX Dept of Hlth 

1100 W 49th St 

Austin TX 78756 

3c 4abcdef 6d 7q 



WIC Prog— TX Dept Hlth 

Shirley Hutchison 

NE Coord 

1100 W 49th 

Austin TX 78756 

2bc 3c 4abc* 6bc 7nh 

EPSDT/TX Dept Humar Resources 

Bridget Cook 

Prog Dir 

PO Box 2960 

Austin TX 78769 

2d 3c 4abc*de*f 6c 7eh 



Vida Y Salud Hlth Systems 

Myrna J Goodman CNM 

BC Coordinator 

308 S 3rd Ave 

Crystal City TX 78839 

2d 3c 4bc* 6d 7bh 



United Med Ctrs 
Melinda Spearman RN C 
PO Box 921 

Eagle Pass TX 78852 
2ab 3c 4c* 6d 7bhu 



Panhandle Planned Parenthood 
604 West 8th 
Amarillo TX 79101 
3c 4abc*def 6ac 7ju 



WIC Prog 

Amarillo Bi-Cy-Cty Hlth Dept 

Jacquelyn D Barone RD LD RN 

41 1 S Austin 

Amarillo TX 79106 

2d 3c 4abc*de* 6d 7nh 



Corp 



Panhandle Rural Hlth 

Willa Albert RN 

PO Box 19130 

Amarillo TX 79114-1130 

3b 4abc* 6bc 7ihm 



New Directions Sch 

Peggy McPeak 

Lubbock Independ Sch Dist 

1301 42nd St 

Lubbock TX 79412 

2c 3a 4abc 6bc 7ahijmu 



WIC & Prenatal— TX Dept Pub Hlth 

503 E Hwy 

Snyder TX 79549 

2d 3c 4abc*d 6d 7nh 



Peri natal Clinic 

Junior League of Midland 

902 W Dengar 

Midland TX 79705 

2b 3c 4abc 6bc 7ihms 



Planned Parenthood of the 

Permian Basin 

Karen Pieper Hildebrand 

910-B S Grant 

Odessa TX 79761 

2d 3c 4abc* 6ac 7j 



City-County Hlth Dist 

Shirley Hutchins RNC 

Dir Nurses 

222 S Campbel 1 

El Paso TX 79901 

2b 3ab 4c* 6d 7chimu 



TX Tech Univ/RE Thomason 
Hosp Nurse Midwifery Svc 
Carolyn Routledge CNM 
Nurse-Midwifery Coord 
4800 Alberta Dept OB-GYN 
El Paso TX 79905 
2d 3c 4abc* 6d 7fhmtu 



La Leche League International 

Christina Mayne 

6728 Paseo Redondo 

El Paso TX 79912 

3c 4c* 6bc 7ko 



Young Parents Prog 
Elizabeth Lund Home 
76 Glen Rd 

Burlington UT 05401 
2d 3ab 4abcdef 6d 7bhm 



WIC Prog— UT Indian Tribe 

Jean P Bl uel iexa 

Box 193 

Ft Duchesne UT 84026 

2c 3c 4d 6bc 7nhmu 



UT Rural Devel 

Donna 01 sen 

12 E Ctr St 

Midvale UT 84047 

2d 3c 4bc*d* 71him 



Salt Lake Cy/Cty Hlth Dept 

Prenatal CI inics 

Cathy Lubatte PHN 

610 S 2nd E 

Salt Lake Cy UT 84111 

2d 3c 4abc*de* 6bc 7ih 



Maternal & Infant Care Clinic 

Marie Miklus 

UT Dept of Hlth 

44 Med Dr 

Salt Lake City UT 84113 

2d 3c 4abc*de 6d 7bhmtu 



WIC Prog— Salt Lake Cy-Cty 

Hlth Dept 

Dawn Higley RN 

WIC Clinic Mgr 

3891 SW Temple 

Salt Lake Cy UT 84115 

2d 3c 4abc*de*f 6bc 7nh 



EFNEP 

UT Prog 

Georgia C Lauritzen 

Coop Ext Svc UT 

UT St Univ UMC 87. 

Logan UT 84322 

2d 3c 4abc*de 6ab 7dh 



160 



RESOURCES 



Weber Morgan Oist Hlth Dept 

Prenatal Prog 

Peg Wehrle NM 

2570 Grant Ave 

Ogden UT 84401 

2bc 3c 4abc*de 6d 7ihu 



ASPO/Lamaze 

Washington DC Chap 

Lynn Wingerd 

446 River Bend Rd 

Great Falls VA 22066 

2c 3c 4abcde 6bc 7bjhsu 



Northern Neck Hlth Dist 

Mar i lyn Carter 

PHN Superv 

PO Box 226 

Warsaw VA 22572 

2d 3c 4abe 6d 7chmu 



WIC Prog— SE UT Dist Hlth Dept 

Kathi Kearney RN 

Box 644 

Castle Dale UT 84513 

2d 3c 4bc* 6d 7nh 

WIC Prog— SW Dist Hlth Dept 

Sheila Finch 

551 S 300 E 

St George UT 84770 

2d 3ab 4abc*d 6d 7nhm 

Smoking S Pregnancy Prog 

American Lung Assn/N VA 

Kay Doggett 

Prog Dir 

9735 Main St 

Fairfax VA 22031 

2c 3c 4a be 6d 7m 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d - All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7i - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 
7m - Substance use 
7n - WIC 

7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Loudoun Cty Hlth Dept 
209 Gibson St NW 
Leesburg VA 22075 
2c 3ab 4abc3 6d 7chimu 



N VA Hlthy Mothers, Healthy 

Babies Coal i tion 

Wendy L Rudolph 

Fairfax Falls Church Comm Svc Bd 

301 Maple Ave W 3rd Fl 

Vienna VA 22180 

2d 3c 4abc*de 6d 7bahim 



Fauquier County Hlth Dept 

Betty S Littleton 

340 Hosp Dr 

Warrenton VA 22186 

2c 3a 4ab 6d 7ahu 



Svc to Military Families/ 

Veterans 

Barbara G Nnoka 

Dir 

American Red Cross/Arlington Cty 

4333 Arl ington Blvd 

Arlington VA 22204 

2c 3c 4abcde* 6bc 7hv 



Maternal Child Hlth Prog 
Bur of Pub Hlth Nursing 
Martha Desrosiers 
Dir of Nursing 

Arlington Dept of Human Svcs 
1800 N Edison St 
Arlington VA 22207 
2d 3c 4abc*e*f 6d 7bhikmopu 



Teen Age Parent 
Jeff Wi 1 son 
Alexandria Pub Sch 
3801 W Brappock Rd 
Alexandria VA 22302 
2c 3a 4abc 6d 7ah 



Confinement Line 
Sue Johnston LCSW 
Potomac Psychological Res 
1225 Martha Custis Dr Ste 2 
Alexandria VA 22302 
2d 3c 4abcde 6d 7it 



Shenandoah Cty Hlth Dept 

Maternal Child Hlth 

Anna K Lindsey RN 

PHN Superv 

PO Box 269 

Woodstock VA 22664 

2d 3c 4ab 6d 7chjmu 



Maternity Group 

Thomas Jefferson Hlth Dist 

Joan M Richard RN 

PO Box 7546 

CharlottesvilleVA 22906 

2d 3c 4ab 6bc 7ihs 



Better Beginnings of Hanover 

and Hanover Hlth Dept 

Nancy Davis 

PO Box 67 

Hanover VA 23069 

2c 3ab 4abc 6ab 7cahjk 



Maternal 6 Child Hlth Grant 

Christine Lucas 

Charles Cy/Goochland Cty 

Hlth Dept 

Hanover CH VA 23069 

2d 3a 4ab 6ab 7ahj 



Mathews Cty Hlth Dept 

S Thomas 

PO Box 26 

Mathews VA 23109 

2c 3ab 4ab 6d 7chu 



Hanover Hlth Dist/New Kent Cty 

Anna Davis FNP 

PO Box 86 

New Kent VA 23124 

2c 3c 4abd 6d 7chmu 



Div Pub Hlth Nutrition 

Doris F Clements 

Pub Hlth Nutrition Superv 

VA Dept of Hlth 

109 Governor St 6th Fir 

Richmond VA 23219 

2c 3c 4abcdef 6b 7h 



161 



RESOURCES 



Richmond Cy Hlth Dept Mobile 

Maternity Intake Svc 

Frances Duston MD MPH 

Dir Pub Hlth 

600 E Broad St Rm 629 

Richmond VA 23219 

2d 3c 4abf 6b 7i 



Love Yourself Love Your Baby 

VA Dept Hlth 

Mareme Martin Staples 

109 Governor St 

Richmond VA 23219 

2c 3ab 4a 6ab 7ihmu 



WIC Prog— VA 

Brenda Morgan 

Info Ofcr 

VA Dept Hlth 

J Madison Bldg 109 Governor St 

Richmond VA 23219 

2d 3c 4abc*de*f* 6d 7nh 



Smoking & Pregnancy/Choking 

American Lung Assn/VA 

Nancy G Loudy 

Richmond Reg Dir 

311 S Blvd 

Richmond VA 23220 

2c 3c 4ab 6bc 7m 

Norfolk Family Planning Proj 

Helen W Taylor MD 

Norfolk Hlth Dept 

1015 E Princess Anne Rd 

Norfolk VA 23504 

2d 3c 4abc 6ac 7cu 

WIC Prog--Cy Norfolk Dept Hlth 

Huntersville Svc Ctr 

Lisa Haedrich 

WIC Nutritionist 

830 Joff St 

Norfolk VA 23504 

2d 3c 4abc*e* 6d 7nhv 

Tidewater Counc on Alcoholism 

Marcel le Hagen 

Ed Dir 

7510 Granby Ste 4 

Norfolk VA 23505 

2bc 3ab 4abce 6ab 7mh 



Norfolk Gen Womens Hlth Pavilion 

Terri Chambers 

Nursing Admin 

600 Gresham 

Norfolk VA 23507 

2c 3ab 4abce 6d 7bh 



Norfolk Perinatal Grant Proj 
Norfolk Dept Pub Hlth 
Barbara Czerwinski 
Perinatal Nurse Superv 
401 Col ley Ave 
Norfolk VA 23507 
2d 3c 4abc 6d 7ihm 



WIC Prog— Norfolk 
Sharon Smith 
Prog Mgr/Nutr i t ionist 
606 W 29th St C 6 Y Proj 
Norfolk VA 23508 
2d 3c 4abc*e* 6d 7nhmo 



Norfolk Comm Svcs Board 
Nancy Jones 

201 Granby Mall Bldg Ste 103 
Norfolk VA 23510 
2c 3ab 4ab 6d 7bhkmr 



E VA Pregnancy Hot Line 
Ingrid Ligeon 

101 St Paul 's Blvd Ste 1100 
Norfolk VA 23510 
2d 3c 4abcdef* 6d 7ih 



Teens-N-Tots 
Audrey H Butler RN 
Nurse Mgr A 
Peninsula Hlth Dist 
416 J Clyde Morris Blvd 
Newport News VA 23601 
2abc 3a 4a 6c 7ak 



East End Hlth Facility 
Doris R Harris 
1033 - 28th St 
Newport News VA 23666 
2c 3c 4ab 6bc 7bhkmuv 



Cradle Crier 

V Nance 

VPI Coop Ext Svc 

PO Box 492 

Yorktown VA 23690 

2c 3b 4abce 6c 7kh 



Chesterfield Cty Hlth Dept 

Maternal/Child Hlth Prog 

Vicki Stamps RN PHN MCH 

Coord 

PO Box 100 

Chesterfield VA 23832 

2d 3c 4abcdef 6d 7chkmrtu 



Colonial Heights Hlth Dept 
200 Highland Ave 
Coin Heights VA 23834 
2d 3c 4abc*def 6d 7chmu 



Maternal & Child Hlth WIC 

Dinwiddie Cty Hlth Dept 

Bonnie Culbreath RN 

PO Box 185 

Dinwiddie VA 23841 

2d 3c 4ab 6d 7nhmu 



Franklin/Southampton Rural 

Infant Care Proj 

Cel ia C Cousins 

Coord 

E VA Med Auth/Hlth Dept 

507 3rd Ave 

Franklin VA 23851 

3ab 4ab 6c 7a 



Piedmont Hlth Dist 
Maternal/Child Hlth Proj 
JoAnne Hughes RN M Ed 
VA Dept Hlth 
110 N Main St 
Farmville VA 23901 
2c 3c 4ab 6bc 7chmt 



Maternal Child Hlth Grant Prog 

Donna Conner RN 

MCH Superv 

Mecklenburg Cty Hlth Dept 

PO Drawer 370 

Boydton VA 23917 

2d 3c 4abc*de 6d 7chimu 



Crisis Pregnancy Ctr 
Ruth Fielder 
2724 B Liberty Rd 
Roanoke VA 24012 
3c 4abcd 6bc 7ihkv 



Prog for Adolescent Pregnancy 

Kathryn B Kel ly 

PO Box 8538 

Roanoke VA 24014 

2bc 3a 4ab 6bc 7abhijmu 



Routine OB Better Babies 
High Risk OB Educ 
Sue Mundy RN 
Perinatal Educ Coord 
Roanoke Mem Hosp-OB/GYN Clinic 
127 McClanakun St SW 
Roanoke VA 24014 
2bc 3c 4abe 6b 7ihmt 



162 



RESOURCES 



Roanoke Childbirth Educ 

& Assoc/ASPO 

Vicki Honer 

PO Box 3204 

Roanoke VA 24015 

2d 3c 4abcde 6d 7ih 



Alleghany Hlth Dist Maternity 

Clinic Svcs 

Linda M French RN MPH 

PO Box 220 

Fincastle VA 24090 

2d 3ab 4abcdef 6bc 7ih 



Alleghany Cty-Covington Hlth 

Dept Prenatal Clinic 

Vivian N Sutphin RN 

PO Box 7^7 

Covington VA 24426 

2c 3c 4ab 6bc 7chmu 



Cooperative Extension Svc — VA 

Polytechic Inst 

Jean Robbins 

US Dept Agriculture 

2728 Colonial Ave SW #10 

Roanoke VA 24015 

2c 3ab 4abc 6bc 7h 



Craig Cty Hlth Dept Maternity 

WIC Pediatric CI inics 

Patricia W Gayle 

PO Box 6 

New Castle VA 24127 

2d 3c 4b 6d 7chmu 



Maternal Svcs/Child Hlth 

Svcs Prog 

Cora LE Christian MD MPH 

Box 520, C'sted 

St_ Croix VI 00820 

2d 3c 4abc 6d 7bhu 



Planned Parenthood of SW VA 

Patty Bundy 

309 Luck Ave 

Roanoke VA 24016 

2bc 3c 4ab 6abc 7jihmu 

Div Pub Hlth Nutrition 
VA Dept Hlth 
El izabeth L Aydlett RD 
1304 Crestview Dr 
Blacksburg VA 24060 
2ab 3c 4ab 6d 7h 

KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Eoth 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d- All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 
7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Dickenson Cty Hlth Dept 

Sharon Trumbley RN 

PO Box 768 

Clintwood VA 24228 

2b 3c 4ab 6d 7chu 



Scott Cty Hlth Dept 

Margaret W Moretz 

Social Worker 

PO Box 668 

Gate City VA 24251 

2c 3c 4ab 6d 7chu 



Lee Cty Hlth Dept 

Margaret W Moretz 

Social Worker 

PO Box 247 

Jonesville VA 24263 

2bc 7ac 3ab 6d 7chu 



Russell Cty Hlth Dept 
Elaine Francisco FPSW 
Box 387 

Lebanon VA 24266 
2c 3c 4ab 6d 7chu 



St Charles Comm Hlth Clinic 

Patricia B Hughes 

Admnin 

PO Drawer S 

St. Charles VA 24282 

2c 3c 4b 6d 7bhim 



Wise Cty Hlth Dept 

Margaret W Moretz 

Social Worker 

PO Box 1409 

Wise VA 24293 

2c 3c 4ab 6d 7chu 



Babysitting 

Betty Jones 

American Red Cross/N VT 

PO Box 508 

Burlington VT 05402 

2b 3a 4b 6c 7khm 



Children & Youth Svcs/WCMH 

Michael O'Hare MD 

9 Heaton St 

Montpelier VT 05602 

2d 3c 4abcde* 6c 7k 



Parent/Child Ctr 

Cheryl Mitchell 

Box 646 

Middlebury VT 05753 

2d 3c 4abcdef 6d 7khimpu 



Child and Family Develop Prog 

Daniel Shea MA 

Administ Dir 

10 Main St 

New Port VT 05855 

2c 3ab 4b 6d 7bhmpu 



Parent-to-Parent 

NE Kingdom Mental Hlth Svc 

Wi nsome A Hami 1 ton 

PO Box 724. 

Newport VT 05855 

2c 3ab 4b 6c 7khjm 



WA Teen Inst 

WA St Counc On Alcoholism 

Brad Coutts 

1882-I36th PI NE Ste 103 

Bellevue WA 98005 

2d 3a 4abcde 6b 7m 



163 



RESOURCES 



Virginia Mason Nurse 

Midwifery Svc 

Michele Domash 

Virginia Mason Hosp 

925 Seneca 

Seattle WA 98101 

3c 4abcde*f 6d 7fhu 



Baby 6 Me 

Cynthia Vom Steeg 

Fam Life Educ/Peninsula Coll 

PO Box 1157 

Forks WA 98331 

2c 3c 4bd 6c 7k 



You and Your Baby 

Mel inda McMahan 

Off Maternal/Child Hlth 

Airdustrial Pk LC-12A 

Olympia WA 98504 

2c 3a 6c 7kv 



Neighborhood Hlth Ctr 

of Seattle 

Susan Sanborn 

905 Spruce St Rm 201 

Seattle WA 98104 

2ab 3c 4abcde* 6d 7ju 



Birth Defects Seminar 

Childrens Orthopedic Hosp 

Cynthia Shurtleff 

M Ed 

Box C5371 

Seattle WA 98105 

2c 3ab 4abcde 6ab 7r 



WIC Prog 

Carolyn Downs Family Med Ctr 

1422 34th Ave 

Seattle WA 98122 

2c 3c 4abc*de*f* 7bc 7nh 



Puget Sound Svc Unit 

Pat Mail 

Hlth Educ 

4735 E Marginal Wy S Rm 1470 

Seattle WA 98134-2381 

2c 3ab 4d 6bc 7gm 



Crisis Pregnancy Ctr/ 

Snohomish Cty 

Karen Ranheim 

2722 Colby 622 

Everett WA 98201 

2d 3c 4abcde 6ab 7i 



Pregnancy Aid of Snohomish Cty 

Roberta Wolcott 

Exec D i r 

PO Box 1317 

Everett WA 98206 

2d 3c 4abc*de* 6d 7behmtu 



Tulalip Tribes Hlth Clinic 
Lola H Deane FMP/CRN 
6700 Totem Beach Rd 
Marysville WA 98270 
2c 3c 4d 6d 7ghkmu 



Little Boston Klallam Hlth Ctr 

Fami ly Practice 

Pamela J Boni 

CRN FNP 

Port Gamble Klallam Tribe 

PO Box 280 

Kingston WA 98346 

2d 3c 4d 6c 7khmu 



Perinatal Proj 

Nita 0_uan 

Coord 

Clallam Cty Hlth Dept 

1502 E Lauridsen Blvd 

Port Angeles WA 98362 

2d 3c 4bde 6d 7chkmuv 



WIC Prog — Lower Elwha 

Zue Hoi the CHN 

WIC Coord 

PO Box 1370 

Port Angeles WA 98362 

2c 3c 4e 6d 7nhjm 

Jefferson Cty Hlth Dept 

Gretchen Gephart 

Dir Nursing 

802 Sheridan 

Port Townsend WA 98368 

2d 3c 4bcd 6d 7chmrtu 

Mary Bridge Childrens 

Hlth Ctr 

Elsie Myers 

Dir Comm Maternal/Child Clinic 

316 North L St 

Tacoma WA 98403 

2c 3ab 4abc*e* 6bc 7hm 

Breastfeeding Prog--Tacoma 
Pierce Cty Hlth Dept 
Sandra Jolley CRN CPNP 
3629 S D St 

Tacoma WA 98408 
2c 3c 4abe 6bc 7no 



Prenatal/WIC Prog 

Tacoma-Pierce Cty Hlth Dept 

Diane Yel ish 

3629 S D St 

Tacoma WA 98408 

2b 3c 4ab 7n 



WIC Prog--WA St 

Loren Bel 1 

WIC Mgr 

DSHS-WIC Prog Mail Stop LC-12C 

Olympia WA 98504 

2bc 3c 4abc*de* 6d 7nhm 



WA Dept Soc/Hlth Svcs—Hlth Ed 

LC-16 

Jim Gl ick 

Superv Hlth Ed 

Olympia WA 98504 

2c 3ab 4ab 6a 7jhm 



WA Traffic Safety Comm Passenger 
Protection Prog 
1000 S Cherry St 
Olympia WA 98504 
2ac 3c 4abcd 6d 7k 



WIC Prog--Cowl ite Family Hlth 
Ctr 

Loretta Hoi land 
WIC Coord 
729 Vandercook Way 
Longview WA 98632 
2d 3c 4abc*de* 6bc 7nhmv 



SW WA Hlth Dis Prenatal Prog 

Kay Koontz 

PO Box 1870 

Vancouver WA 98668 

3c 4abc*de* 6bc 7ch 



Yakima Hlth Dist 

Cheryl Cornell RNP 

104 N 1st St 

Yakima WA 98901 

2bc 3c 4abc*de* 6bc 7ihmu 



WIC Prog--Nei ghborhood 

Hlth Svcs 

Mary Jo Mengarelli RD 

12 S 8th St 

Yakima WA 98901 

2d 3c 4abc*de 6bc 7nhmo 



164 



RESOURCES 



Prenatal Referral Prog 

Ctl WA Perinatal Prog 

Gail Weaver or Sandy Shaver 

Yakima Valley Mem Hosp 

2811 Treton Dr 

Yakima WA 98902 

2d 3c 4abc*de 6d 7i 



WIC Prog--WA St Migrant Counc 

Sara Sue Wohlcke RN 

WIC Coord 

804 Decatur 

Sunnyside WA 98944 

2d 3c 4abce* 6d 7nh 



Cooperative Extension 
WA St Univ 
Sue Butkus 
Nutrition Spec 
Agricultural Sci Bldg 
Pullman WA 99164 
2b 3ab 4abcde 6d 7hm 



KEY 



The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Age(s) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d- All 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7h - Nutrition 
7i - Prenatal 
7i - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n - WIC 
7o - Breastfeeding 
7p - Child abuse 
7q - Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Columbia Basin Hlth 

Nancy Blaisdel 1 RN 

P0 Box 546 

Othello WA 99344 

2c 3c 4bc* 6d 7chmu 



WIC Prog 

Walla Walla Cty-Cy Hlth Dept 

Joan Perry 

Prog Dir 

310 W Poplar 

Walla Walla WA 99362 

2d 3c 4abcde 6d 7nhm 



Asotin Cty Hlth Dept 

E Lyden RN 

431 Elm St 

Clarkston WA 99403 

2bc 3c 4bdf 6bc 7ch 



Assn for Retarded Citizens 
-Prev Prog 
Susan Stang 
Prev Coord 
611 E Wells St 
Milwaukee Wl 53202 
2d 3c 4abc*d 6d 7ihr 



16th St Comm Hlth Ctr 

Lynne D De Broin - Hlth Educ 

Coord 

1032 S 16th St 

Milwaukee Wl 53204 

2d 3c 4bc*e* 6d 7bhikmnpu 



Milwaukee Cty Dept of Social 

Services -Parent Educ 

Paul Reinelt 

Coord 

1220 W Vliet St 

Milwaukee Wl 53205 

2d 3c 4abc*de 6bc 7khk 



La Leche League Milwaukee 
Al ice Rouleau 
Area Professional Liaison 
3971 S Whitnal 1 Ave 
Milwaukee Wl 53207 
2c 3c 4bc 6bc 7o 



Milwaukee Indian Hlth Board 

Barbara Vitucci 

930 N 27th St 

Milwaukee Wl 53208 

2d 3c 4abcde 6d 7ghkmu 



Early-On 

Barbara Gardner 

Next Door Found 

736 N 31 

Milwaukee Wl 53208 

2c 3b 4abcd 6c 7khv 



Genesis Outpatient Drug & 
Alcohol Treatment Prog 
Nathan J Bryer 
3034 W Wisconsin Ave 
Milwaukee Wl 53208 
2d" 3c 4abcd 7m 



Family Hosp Teen Pregnancy Svc 

Mary Jo Baisch 

Dir 

2711 W Wells 

Milwaukee Wl 53208 

2b 3a 4abcd 6bc 7ahu 



Day Care Preschool Hlth Prog 
Gloria Rhone RN 
5622 N 36th St 
Milwaukee Wl 53209 
2c 3c 4abc*e 6d 7k 



Inner Cy Devel Proj-- 
Capitol Drive CHC 
Cindy Legrand-Hosale 
2411 W Capitol Dr 
Milwaukee Wl 53211 
2c 3ab 4a 6d 7ih 



Prenatal Educ and Assessment 

Prog 

Colleen Landazuri RN 

Mi lwaukee Hlth Dept 

3200 N 36th St 

Milwaukee Wl 53216 

2bcd 3a 4abcde 6abc 7abhimu 



Breathing for Two 
American Lung Assn/WI 
Martha Stol Iberg 
10001 W Lisbon Ave 
Milwaukee Wl 53222 
2c 3c 4abcd 6d 7m 



March of Dimes Birth Defects 

Found 

Bonnie J Jachowicz RN 

2949 N Mayfair Rd 

Wauwatosa Wl 53222 

2d 3c 4abcd 6a 7jhmu 



165 



RESOURCES 



Samaritan Hlth Plan 
Marilyn Bromley RN 
Med Svcs Superv 
2040 W Wisconsin Ave 
Milwaukee Wl 53233 
2d 3c 4abcde 6d 7bhmu 

Preparation for Parenthood 

Parenting from 1-6 

Sue Weber RN 

Comm Hlth Ed Coord 

American Red Cross/Milwaukee 

2600 W Wisconsin Ave 

Milwuakee Wl 53233 

2c 3ab 4abd 6bc 7bhj 



Caring Connection 

Susan Waditwani 

St Lukes Hosp 

Racine Wl 53403 

2bc 3ab 4abcd 6d 7aijkpuv 



Early Pregnancy Class 

Mercy Hosp 

Cathy Flanagan RN 

Hlth Ed Instr 

1000 Mineral Point Ave 

Janesville Wl 53545 

3b 4b 6b 7ihm 



EPSDT/WI Div Hlth 

Charles T Treval lee 

Prog Mgr 

PO Box 309 

Madison Wl 53701 

2b 3ab 4abc*de 6c 7e 



MCH Unit— Bur Comm Hlth/Prev 

Wl Div Hlth 

Anita H Grand RN CNM 

PO Box 309 

Madison Wl 53701 

2bc 3ab 4abc*de* 6d 7chp 



Wisconsin Nutrition Proj 
Theresa Hadley 
1045 E Dayton St Rm 204 
Madison Wl 53703 
2c 3c 4abc*de* 6d 7o 



Single Parent Hlth Info Prog 

Madison Urban League 

Betty A Frankl in 

151 E Gorham St 

Madison Wl 53703 

2c 3ab 4abc 6c 7kh 



Univ Wl-Extension 

Fami ly Living Educ 

Jane Voi chick 

432 N Lake St 

Madison Wl 53706 

2bc 3c 4abc*d 6d 7dh 



Statewide Genetics Svcs Network 

Univ Wl 

Raymond Kessel 

104 Genetics Bldg 445 Henry Mall 

Madison Wl 53706 

2c 3a 4abcdef 6ab 7ahr 



Marquette Cty Pub Hlth Svc 

Ruby Dow 

PO Box 1 81 

Montello Wl 53949 

2bc 3ab 6bc 7ch 



WIC Prog--Door Cty Pub Hlth 

Nursing Svc 

Diane Moreau 

1715 Rhode Island St 

Sturgeon Bay Wl 54235 

2d 3c 4abc*de 6d 7nhm 



WIC Prog--NEW Comm Clinic 

Trudy Hagstrom 

WIC Prog Coord Brown Cty 

PO Box 2526 

Green Bay Wl 54306 

2d 3c 4abc*de* 6bc 7nhmv 



Wausau Insurance Co 

Hlth Svcs 

Barb Lepinski RN 

2000 Westwood Dr 

Wausau Wl 54401 

2d 3b 4b 6ab 7hjmov 



Price Cty Nursing Svc 

Vickie Petrashek RN 

Courthouse 

Phillips Wl 54555 

2bc 3c 4b 6d 7bh 



La Crosse Lutheran Hosp 

Teen Hlth Svc 

Tim Skinner 

Proj Adm 

1910 South Ave 

La Crosse Wl 54601 

2bcd 3ab 4abcdef 6d 7abhjk 



Unified La Crosse Reg Infant 

Intensive Care Prog 

Sue Murvich 

PO Box 1326 

La Crosse Wl 54601 

2d 3c 4abcdef 6c 7kh 



Fami 1 y Life Ed- 
Parenting Your Child From 1-6 
Mary Anne M Snyder 
LaCrosse Cty Hlth Dept 
1707 Main St 

LaCrosse Wl 54601 
2c 3b 4b 6c 7khv 



La Crosse Breastfeeding 

Task Force 

Donell Kerns 

Coord 

Grandview Bldg 1 707 Main St 

La Crosse Wl 54601. 

2c 3c 4be* 6d 7ok 



WIC Prog—Jackson Cty 

JoAnn Wegenke 

PO Box 310 

Black River FlsWI 54615 

2b 3c 4bd 6bc 7nh 



OSSEO Area Hosp 
Margaret L. Lunde RN 
Ob Superv 

Osseo Wl 54758 
2c 3c 4bde 6d 7bhm 



"It's A New Life" 

Teen Pregnancy Prog 

Carol Heid RN 

OB Ed Coord 

1818 N Meade 

Appleton Wl 54911 

2cd 3a 4bc 6bc 7ahu 



WIC Prog— Ctl Wl 

Gail Yest 

PO Box 191 

Wild Rose Wl 54984 

2d 3c 4abc*e 6d 7nhm 



166 



RESOURCES 



Winnebago Cty Pub HI th Nursing 

Svc Maternal-Child Hlth Prog 

Janice M Gebheim RN 

PO Box 68 

Winnebago Wl 54985 

2d 3c 4be* 6d 7chm 

Winnebago Cty Family 

Planning Clinic 

Kathy Wenzel RN/MSN 

PO Box 68 

Winnebago Wl 54985 

2c 3a 4abe 6a 7j'hmuv 

Winnebago Cty Pub Hlth 

MCH Nutrition 

Connie Eiseh 

Box 68 

Winnebago Wl 54985 

2c 3b 4b 6d 7ch 

WIC Prog — Winnebago Cty 

Barbara Sheldon RD 

PO Box 68 

Winnebago Wl 54985 

2d 3c 4abc*de* 6bc 7nh 



KEY 

The codes following each respondent organization name 
and address correspond with these program 
characteristics: 

Reading level 

2a - Illiterate 

2b - lst-3rd and 4th-6th grades 

2c - 7th-9th and 10th grade and above 

2d - all levels 

Agets) 

3a - Teenager 

3b - Young adult and older adult 

3c - Both 

Ethnic group(s) 

4a - Black 

4b - White 

4c - Hispanic 

4d - Native American 

4e - Asian/Pacific Islander 

4f - Other 

Language(s) 

Asterisk after ethnic group above indicates use of 
language other than English 

Stage(s) 

6a - Pre-pregnancy 

6b - Pregnancy 

6c - Post-partum, newborn, infancy 

6d-AH 

Special Problems Addressed 

7a - Adolescent Pregnancy 
7b - Comprehensive 

7c - Comprehensive program/health department 
7d - EFNEP 
7e - EPSDT 
7f - Midwife programs 
7g - Native American 
7n - Nutrition 
7i - Prenatal 
7j - Pre-pregnancy 
7k - Postnatal/parenting 
71 - Rural 

7m - Substance use 
7n-WIC 

7o - Breastfeeding 
7p - Child abuse 
7q • Dental Care 

7r - Genetic counseling, birth defects 
7s - Lamaze/preparation for delivery 
7t - Medically high-risk 
7u - Sexually transmitted diseases 
7v - Life skills 



Prenatal/Family Plng/lnfant 

Mortality Reduc/Ped Clinics 

Mona Blackwel 1 

Mercer Hlth CI inic 

RT 2 Box 382 

Bluefield WV 24701 

2d 3c 4ab 6d 7ihmu 



Statewide Family Ping Prog 

Tri-Dist Comm Hlth 

Wanda SI over RN 

PO Box 48 

Algoma WV 24807 

2c 3c 4ab 6a 7jhu 



Maternal Infant Hlth 

Outreach Workers (Ml HOW) 

Darlene Kent 

Tug River Clinic Assoc 

Box 507 

Gary WV 24836 

2c 3c 4ab 6bc 7bhmou 



Greenbrier Cty Hlth Dept 
295 Seneca Trail 
Ronceverte WV 24970 
2c 3b 'tab 6ab 7chjkmu 



Clay Cty Hlth Dept 

Rene Hybbard 

Box 36 

Clay WV 25043 

2c 3b 4b 6bc 7chmu 



WV Dept of Hlth 
-Maternity Svcs Prog 
Pat Moore-Mass 
1143 Dunbar Ave 
Dunbar WV 25064 
3c 4abc* 6d 7chijmu 



WIC Prog — Kanawha Cty 
Mol ly Szymanski 
1217 A Stewart Plaza 
Dunbar WV 25064 
2c 3c 4abe 6d 7nh 



Birth Ctr 

H Delfos-Broner CNM 

Coord 

Womens Hlth Ctr WV 

3418 Stauntor Ave 

Charleston WV 25304 

2d 3c 4abcde 6d 7ihku 



Flouride Supplement Prog 

WV St Hlth Dept 

John Wilson DDS 

Dir Dental Div 

1800 Washington St E 

Charleston WV 25305 

2c 3b 4ab 6c 7q 



Smoking & Pregnancy Prog 
American Lung Assn/WV 
Kathi Elkins 
PO Box 3980 

Charleston WV 25339 
2c 3b 6b 7m 



Wayne Cty Hlth Dept 

Prenatal Clinic 

Sue El len Cyrus 

Prenatal Clerk/OB Clinic 

PO Box 368 

Wayne WV 25570 

2c 3c 4b 6d 7chmu 



Maternal Infant Hlth Outreach 

New River Fam Hlth Ctr 

Linda Stein 

PO Box 337 

Scarbro WV 25917 

2d 3c 4ab 6bc 71 hi k 



Parent Ed 6 Family Intervention 

Helen Wi 1 son 

PO Box 4246 

Parkersburg WV 26101 

2d 3c 4b 6ab 7ihmu 



Youth Hlth Svc 

Frances L. Jackson, RN MN 

Dir 

PO Box 1759 

Elkins WV 26241 

2bcd 3ab 4b 6abc 7ah 



Child Care and Development 

Class 

C Cough 1 in 

Washington Irving HS 

Lee Ave 

Clarksburg WV 26301 

2c 3a 4ab 6d 7ahmu 



State Maternity Prog 

Diane Kyle RN 

PO Box 337 

Glenville WV 26351 

2d 3c 4b 6d 7ihm 



167 



RESOURCES 



Statewide Maternity Prog 
Lewis Cty HI th Dept 
PO Box 1750 

Weston WV 26A52 
2c 3b 4be 6b 7c 



Tri-Cty Devel 
Carol Rucker 
PO Box 100 
Guernsey WY 
2d 3c 4bc* 7bh 



82214 



Prenatal Prog 

Nicholas Cty Pub HI th Dept 

Dana Hoi brook RN 

1 Stevens Rd 

Summersvi 1 le WV 26651 

2c 3c 4b 6d 7ihmu 



WY Womens Ctr New Mothers 

Support Group 

Denise Smith 

Box 210 

Lusk WY 82225 

2d 3b 4b 6bc 7km 



WIC Prog 

Susan M Kimble 

PO Box 935 

Keyser WV 26726 

2c 3c 4abc* 6d 7nh 



EFNEP— Univ WY Coop Ext Svc 

Karen Ross 

US Dept Agric 

1700 Snyder 

Cheyenne WY 82001 

2c 3c 4abc*def 7dh 



Hlth Risk Reduction Prog 
WY Div Hlth/Med Svcs 
Menlo Futa 
Chathaway Bldg 
Cheyenne WY 82002 
2d 3c 4abcdef 6a 7ihmtu 



WIC Prog — Shoshone 
Arapahoe Tribes 
Chris Fogelman RD 
Box 217 

Fort Washakie WY 
3c 4d 6bc 7nhm 



82514 



Cradle Cryer 

Linnet McGoodwin 

Univ WY Agric Ext Svc 

Box 4006 

Sheridan WY 82801 

2c 3b 4bcd 6c 7kh 



W WY Family Ping 

Vivian Dixon 

Box 1066 

Kemmerer WY 83 101 

2c 3c 4abc 6ab 7ju 



Family Hlth Svcs and WIC Prog 
WY Dept Hlth/Social Svcs 
R Larry Meul i MD 
Hathaway Bldg 4th Fl 
Cheyenne WY 82002 
2c 3c 4abc*de 6bc 7nhm 



EFNEP/Univ WY 

Linda Melcher 

Coop Ext Svc/WY 

PO Box 3354 

Univ St LaramieWY 82071 

2d 3c 4abcde 6d 7dhm 



DDD 



■&U.S. GOVERNMENT PRINTING OFFICE: 1986-166-410 



168 



Dear Healthy Mothers, Healthy Babies Coalition: 

n Please send me information about joining the Coalition. 

I represent a national organization interested in maternal and infant care. 

L I Please send me information about forming a community/State chapter of the Healthy 
Mothers, Healthy Babies Coalition. 

Name 

Organization 

Street 



City State Zip 



I have these comments about the Compendium (please include suggestions for future editions): 



W 
PCS 
W 

H 

O 

O 



Mail to: 

Healthy Mothers, Healthy Babies National Coalition 
600 Maryland Avenue, S.W., Suite 300E 
Washington, DC 20024-2588 



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U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES 
Public Health Service 

Health Resources and Services Administration 
Bureau of Health Care Delivery and Assistance 

DHHS Publication No. (PHS) 86-50209